CMV Retinitis: The Diagnostic Challenges and Long-Term Outcomes. The Experience of Tertiary Eye Center in Saudi Arabia

CMV Retinitis: The Diagnostic Challenges and Long-Term Outcomes. The Experience of Tertiary Eye Center in Saudi Arabia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article CMV Retinitis: The Diagnostic Challenges and Long-Term Outcomes. The Experience of Tertiary Eye Center in Saudi Arabia Abdulrahman AlZaid, Abdulrahman Khan, Hassan Al-Dhibi, Moustafa S. Magliyah This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7358381/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 11 Mar, 2026 Read the published version in Journal of Ophthalmic Inflammation and Infection → Version 1 posted 6 You are reading this latest preprint version Abstract Purpose To describe the clinical features, complications, and long-term visual outcomes of cytomegalovirus (CMV) retinitis in patients presenting to a tertiary eye center. Methods A retrospective chart review of patients who were diagnosed with CMV retinitis between 2014 and 2024. Results Twelve eyes of 8 patients were included. Five patients (62.5%) were males and 3 (37.5%) were females. All patients were immunocompromised. Four patients (40%) were on immunosuppressive medications after renal transplantations for chronic renal failure (CRF), three patients had human immunodeficiency virus (HIV) infections, and one patient had a congenital immunodeficiency disease. The baseline best-corrected visual acuity (BCVA) was 0.8 ± 0.9 (Snellen = 20/125). Seven eyes (58.3%) had a hemorrhagic type of retinitis, and 5 eyes had granular retinitis (41.7%). Vitritis was found only in 2 eyes (16.7%), vasculitis was found in 3 eyes (25%), and occlusive vasculitis was found in 2 eyes (16.7%), and all of these features were present in patients who were non-HIV infected. The mean BCVA on the last visit was 0.9 ± 1.2 (Snellen = 20/160). Visual threatening complications included macular atrophy, optic disc pallor, rhegmatogenous retinal detachment (RRD), and NVG. Conclusion The clinical picture of CMV retinitis is better related to the level of immunity than the classification of HIV vs non-HIV related. Signs of inflammatory response were absent in HIV-infected patients. CMV retinitis HIV retinal detachment Valganciclovir immunocompromised status Figures Figure 1 Figure 2 Figure 3 Introduction Cytomegalovirus (CMV) is an opportunistic virus that belongs to the Herpesviridae family, which are double-stranded DNA viruses that vary in size between 120 and 160 nm. CMV has a prevalence of about 50–88% in the general population [ 1 , 2 ]. CMV retinitis is a clinical term which describes the reactivation of the CMV leading to prominent retinal inflammation in the absence of anterior chamber reaction or vitritis as a result of compromised immune status [ 1 ]. Before the era of human immunodeficiency virus (HIV), CMV retinitis was observed mainly in iatrogenically immunosuppressed patients, including transplant recipients and patients receiving chemotherapy [ 3 – 7 ]. After the emergence of HIV, CMV retinitis was commonly found in patients with HIV infection and low CD4 counts [ 8 – 10 ]. In addition, patients who have undergone organ transplantations are predisposed to CMV retinitis [ 11 – 16 ]. The development of Highly Active Antiretroviral Therapy (HAART), which controls the replication of HIV and induces immune restoration, in addition to the advances in the immunosuppressive treatment options after organ transplantation, allowed for a better understanding of the clinical picture and outcomes of CMV retinitis [ 10 , 13 , 14 ]. Two clinical pictures of CMV retinitis have been described: a fulminant picture that presents with confluent necrotizing retinitis and dispersed retinal hemorrhages, and an indolent picture characterized by a granular retinitis with few or absent hemorrhages. In a previous study, which compared the clinical pictures of CMV retinitis in HIV infected and non-HIV-infected patients, the presence of vitritis, vasculitis, and vascular occlusion was more commonly found in non-HIV patients [ 13 ]. However, with the emergence of infectious diseases that are usually seen with compromised immune status in the Middle East and Gulf regions, more data about the clinical pictures and outcomes of these diseases are needed [ 17 ]. In this paper, we aim to describe the clinical pictures and long-term outcomes of CMV retinitis in patients with and without HIV infections presenting to a tertiary eye center. Methods This is a retrospective interventional cohort study that included all patients who presented with a clinical picture suggestive of CMV retinitis and had their diagnosis confirmed by polymerase chain reaction (PCR) testing. This study was approved by the Institutional Review Board (IRB) at King Khaled Eye Specialist Hospital (KKESH) with IRB number 25133-R, and the study adhered to the tenets of the Declaration of Helsinki. The electronic files at KKESH were searched for the terms (cytomegalovirus retinitis) and (CMV retinitis) to search for cases from 2014 to 2024. Cases of acute retinal necrosis (ARN), ocular syphilis disease, and cases that were not confirmed by PCR testing were excluded. The diagnosis of CMV retinitis was based on the classification criteria of CMV retinitis approved by the Executive Committee of the Standardization of Uveitis Nomenclature (SUN) Working Group in 2021 [ 18 ], which include the following criteria: 1. Necrotizing retinitis with indistinct borders due to numerous small satellites. 2. Evidence of immune compromise. 3. Either a characteristic clinical appearance or positive polymerase chain reaction assay results for CMV from an intraocular specimen. A detailed review of the electronic records of all included patients was performed, including detailed immunological history, ophthalmic examination on presentation, PCR test results, systemic and ocular treatments, ocular complications, and final visual outcomes. Multimodal retinal imaging, including fundus photography (Optos PLC, Dunfermline, UK) and spectral domain optical coherence tomography (SD-OCT; Spectralis, Heidelberg engineering, Hiedlberg, Germany), was performed. The data were analyzed using IBM SPSS Statistics version 26.0 (IBM, Armonk, NY, USA). Frequencies and percentages were computed to describe categorical data. Means with standard deviations were computed to describe continuous data. Chi-squared test was used to compare categorical data, and analysis of variance (ANOVA) was used for comparison of numerical data. A P-value of < 0.05 at 95% confidence interval (CI) was considered significant. Whenever possible, the odds ratio was calculated at 95% CI to analyze the risks. Results Twelve eyes of 8 patients were included. Five patients (62.5%) were males and 3 (37.5%) were females. All patients were immunosuppressed for 9.2 ± 6.9 years. Four patients (40%) were on immunosuppressive medications after renal transplantations for chronic renal failure (CRF). The reasons for CRF were uncontrolled diabetes and hypertension in 3 patients and lupus nephritis in one patient. One patient had a congenital immunodeficiency disease, and three patients had human immunodeficiency virus (HIV) infections. Three patients were on oral prednisolone, and one patient was on Tacrolimus. Four patients (50%) had bilateral involvement, and 4 patients had unilateral involvement. Five eyes (41.7%) were right eyes, and 7 eyes (58.3%) were left eyes. The baseline best-corrected visual acuity (BCVA) was 0.8 ± 0.9 (Snellen = 20/125). Vitritis (Supplementary Fig. 1) was found only in 2 eyes (16.7%). Seven eyes (58.3%) had a hemorrhagic type of retinitis (Supplementary Fig. 2), and 5 eyes had granular retinitis (41.7%). Table 1 shows the clinical examination details of the 12 eyes included in the study. All eyes had positive polymerase chain reaction (PCR) tests for CMV from aqueous samples. All patients were treated with oral valganciclovir 900 mg twice daily for 21 days, followed by once daily. The total duration of treatment with oral valganciclovir was 5.4 ± 4.2 months. Five eyes (41.7%) were treated with intravitreal ganciclovir with an average of 6.4 ± 1.5 injections. All three patients with HIV infections were treated with Highly Active Antiretroviral Therapy (HAART). Optic nerve involvement was observed in two eyes on presentation. In one eye, it was an early involvement which was improved with treatment and resulted in 20/60 vision, while optic involvement was extensive and resulted in total optic disc pallor and no light perception (NLP) vision in one eye (Supplementary Fig. 3). Rhegmatogenous retinal detachment (RRD) developed in 3 eyes (25%), 2 eyes of HIV patients, and one eye of a post-renal transplantation patient on immunosuppressive medications. Two RRDs had surgical repairs with pars plana vitrectomy, endolaser, and silicone oil (Fig. 1 ). One of the operated eyes developed neovascular glaucoma (NVG) and was treated with Ahmed Glaucoma valve (AGV) implantation. One eye in an HIV patient who was not compliant with HAART treatment had progressive retinitis, which later involved the optic nerve and resulted in an RRD that was deemed inoperable (Fig. 2 ). In addition, the central nervous system was later involved, and the patient developed encephalitis and ependymitis. Total resolution of retinitis without visual threatening complications was achieved in 6 eyes (50%), including one eye which had an early optic disc involvement (Fig. 3 ). There were no significant differences between eyes that had HIV infections and eyes that did not have HIV infections. Table 2 shows the comparisons between the eyes of patients with HIV infections and eyes with other causes of immunosuppression. The mean BCVA on the last visit was 0.9 ± 1.2 (Snellen = 20/160), and the mean IOP was 15.1 ± 5.1 mmHg. The change in BCVA was statistically significant (P = 0.027). There were marginally insignificant relationships between macular involvement of retinitis (P = 0.091, OR = 3.0) and the incidence of RRD (P = 0.091, OR = 3.0) with poor visual outcomes. Table 3 shows the relationship analysis between several factors and poor visual outcomes. Discussion In this paper, we describe the clinical features and management outcomes of CMV retinitis in a tertiary eye center. In the HIV era, care needs to be taken not to misdiagnose or delay the diagnosis of this vision-threatening disease [ 16 , 17 , 19 ]. Previous studies suggested that, unlike HIV infected patients, the clinical picture of CMV retinitis in non-HIV retinitis patients more commonly involves vitritis, vasculitis, and occlusive vasculitis, leaning towards the clinical picture of acute retinal necrosis (ARN) commonly caused by herpes simplex and herpes zoster viruses [ 13 , 15 , 16 ]. This study also shows that vitritis and vasculitis were found in the non-HIV subset of patients and were absent in HIV infected patients. This might be related to the fact that CMV can potentiate the pathogenicity of HIV by activating HIV, increasing the intracellular transport of HIV, and affecting CD8 T cell function. CMV also increases HIV viral replication, further decreasing the immunity of the hosts [ 20 ]. On the other hand, some reports suggested that patients with non-HIV infection-related CMV retinitis had quiet eyes with absence of vitritis and anterior chamber reactions [ 11 ]. In our experience, we found that the term (non-HIV) is a generalized term that lumps multiple causes of immunocompromise together. Patients who had renal transplantations in this series developed vitritis and anterior chamber reactions, while vasculitis was present in a patient who had renal transplantation and a patient who had a severe congenital immune deficiency and ended up with occlusive vasculitis in the latter patient. Notably, patients with non-HIV-infected CMV retinitis presented with lower visual acuity, larger extent of retinitis, and a higher risk of macular involvement. These findings were similar to previous findings in these patients [ 12 ]. However, there was less zone I retinitis involvement and incidence of vasculitis. These differences might be explained by the heterogeneity of the causes of compromised immunity in these patients. The overall incidence of RRD in our patients was 25% and was slightly higher among patients with HIV-related CMV retinitis. This is slightly higher than previously reported rates of RRD in CMV retinitis and might be explained by the larger extent of retinitis leading to RRD [ 11 , 15 , 21 ]. The higher risk of RRD in eyes with a larger extent of retinitis was also found in ARN and was more commonly seen in eyes with multifocal or diffuse retinitis [ 22 ]. However, unlike ARN, which had an increased risk of RRD with higher grades of vitritis, RRD in CMV retinitis was not related to vitritis [ 22 ]. This might be explained by the low grades of vitritis in CMV retinitis, which result in minimal inflammatory changes that contribute to the mechanism of RRD. Nevertheless, the inflammatory component in RRD formation is an important contributor, as the risk of RRD in ARN eyes is much higher (56%) than in eyes with CMV retinitis. Other complications that affected visual outcomes in this study include retinal atrophic changes from proximal involvement of retinitis, optic nerve involvement, and neovascular glaucoma (NVG). Previous studies have also reported these complications in CMV retinitis [ 11 , 16 , 23 ]. NVG is thought to be caused by peripheral retinal ischemia induced by a large area of retinitis.16 In our study, one eye had NVG after undergoing a surgical repair for RRD in which laser was applied to the areas of retinitis, indicating that retinal ischemia is not limited to and does not correspond to the area of retinitis. Appropriate and timely laser photocoagulation application to the ischemic retina helps avoid the ischemia-related complications of NVG and vitreous hemorrhage. Optic nerve involvement was observed in 2 eyes of 2 patients: One HIV infected patient and one with severe congenital immunodeficiency, resulting in total optic disc pallor in one eye and good visual recovery in response to HAART and systemic and local treatment in one eye. The importance of early recognition of optic disc involvement in CMV retinitis cannot be overemphasized. Another condition that needs to be differentiated from optic nerve involvement in CMV retinitis is neuroretinitis, either infectious or non-infectious. In addition to the classical picture of hemorrhagic or granular retinitis of CMV infection, neuroretinitis usually involves more prominent vitreous involvement in the form of prepapillary vitreous opacities in non-infectious neuroretinitis and higher grades of focal or diffuse vitritis in toxoplasmosis-related neuroretinitis and macular exudation in cat-scratch disease [ 24 ]. Macular involvement was noted in 3 eyes and affected the visual outcomes. Poor visual outcomes as a result of macular involvement were also observed in previous studies [ 12 ]. The reason for these outcomes is the retinal atrophic changes, which persist even after the administration of proper treatments. All of our patients were treated with Valganciclovir, and intravitreal ganciclovir was administered to 41% of eyes in our patients. The reasons for not giving intravitreal injections in the remaining eyes included patient refusal, limited availability, and total visual loss beyond salvation. In addition, HAART constitutes an integral part of management in patients infected with HIV. The non-compliance with the treatment in one patient resulted in more extensive CMV retinitis and eventually inoperable RRD, leading to total visual loss as the other eye was lost before presentation. This study has several limitations, including the retrospective nature, the differences in clinical assessments, investigations, and treatment regimens between the treating physicians, and small patient numbers. Importantly, there are several factors that contributed to the limited number of patients. These factors include patient-related social and cultural barriers, limited access to tertiary eye care for patients who are debilitated or severely immunocompromised, and the loss to follow-up in some patients, preventing the assessment of treatment efficacy. Despite these limitations, the current study provides real-world data regarding the clinical features of patients with and without HIV infection in a region where data about this disease are lacking, and adds to the body of evidence on long-term outcomes of CMV retinitis. In conclusion, the clinical features of CMV retinitis are more accurately related to the level of immunity than to the classification of HIV vs non-HIV CMV retinitis. The absence of vitritis, vasculitis, and occlusive vasculitis is an important feature of HIV-related CMV retinitis. This indicates an absence of inflammatory reaction and an inability to fight the opportunistic viral infection. Timely recognition and appropriate treatment are critical to achieve better long-term visual recovery and avoid vision-threatening complications like RRD, macular atrophy, optic nerve involvement, and NVG. Declarations Ethical Approval: This study adhered to the tenets of the declaration of Helsinki at 1964 and its amendments. The study was approved by the Institutional review board (IRB) at King Khaled Eye Specialist Hospital (KKESH), IRB number: RP 22013-R. Author Contributions : AA, AK, HA and MM: conceptualization and design; data acquisition, analysis, and interpretation and drafting the manuscript. AA and AK: conceptualization and design; HA and MM: critically revising the manuscript. The final version of the manuscript was approved by all authors. Consent to participate: Informed consents were obtained from all participants included in this study. Consent for Publication: Informed consents were obtained from all participants to publish the study material. Data availability: All data generated or analyzed during this study are included in this article. Further enquiries can be directed to the corresponding author. Conflict of interest: None of the authors have any conflict of interest to disclose. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. Funding : None for each author. Disclosure of interest : The authors report there are no competing interests to declare References Jabs DA. Cytomegalovirus retinitis and the acquired immunodeficiency syndrome–bench to bedside: LXVII Edward Jackson Memorial Lecture. Am J Ophthalmol. 2011;151(2):198–216. e191. doi:10.1016/j.ajo.2010.10.018. Bakir TM. Prevalence of antibodies to herpesviruses in central Saudi Arabia. Ann Saudi Med 1987;7:196‑201. https://doi.org/10.5144/0256-4947.1987.196. Murray HW, Knox DL, Green WR, Susel RM. Cytomegalovirus in adults. Am J Med 1977;63:574–584. Coskuncan JM, Jabs DA, Dunn JP, et al. The eye in bone marrow transplantation: retinal complications. Arch Ophthalmol 1994;112:372 379. Egbert PR, Pollard RB, Gallagher JG, Merigan TC. Cytomegalovirus retinitis in immunosuppressed hosts: ocular manifestations. Ann Intern Med 1980;93:664–670. Jabs DA, Wingard JR, de Bustros S, et al. B759U for cytomegalovirus retinitis: intraocular drug penetration. Arch Ophthalmol 1986;104:1436–1437. Maguire AM, Nichols CW, Crooks GW. Visual loss in cytomegalovirus retinitis caused by cystoid macular edema in patients without acquired immune deficiency syndrome. Ophthalmol 1996;103:601–605. Holland GN, Vaudaux JD, Jeng SM, et al. Characteristics of untreated AIDS-related cytomegalovirus retinitis. I. Findings before the era of highly active antiretroviral therapy (1988 to 1994). Am J Ophthalmol. 2008 Jan;145(1):5-11. doi: 10.1016/j.ajo.2007.09.023. PMID: 18154750. Holland GN, Vaudaux JD, Shiramizu KM, et al. Characteristics of untreated AIDS-related cytomegalovirus retinitis. II. Findings in the era of highly active antiretroviral therapy (1997 to 2000). Am J Ophthalmol. 2008 Jan;145(1):12-22. doi: 10.1016/j.ajo.2007.09.040. PMID: 18154751. Agrawal R, Gunasekeran DV, Xu Y, et al. Clinical Features and CD4+ T Cell Count in AIDS Patients with CMV Retinitis: Correlation with Mortality. Ocul Immunol Inflamm. 2022 Jan 2;30(1):42-47. doi: 10.1080/09273948.2020.1772312. Epub 2020 Jul 9. PMID: 32644842. Kuo IC, Kempen JH, Dunn JP, Vogelsang G, Jabs DA. Clinical characteristics and outcomes of cytomegalovirus retinitis in persons without human immunodeficiency virus infection. Am J Ophthalmol. 2004 Sep;138(3):338-46. doi: 10.1016/j.ajo.2004.04.015. PMID: 15364214. Iu LP, Fan MC, Lau JK, et al. Long-term Follow-up of Cytomegalovirus Retinitis in Non-HIV Immunocompromised Patients: Clinical Features and Visual Prognosis. Am J Ophthalmol. 2016 May;165:145-53. doi: 10.1016/j.ajo.2016.03.015. Epub 2016 Mar 19. PMID: 27005706. Ho M, Invernizzi A, Zagora S, Tsui J, Oldani M, Lui G, McCluskey P, Young AL. Presenting Features, Treatment, and Clinical Outcomes of Cytomegalovirus Retinitis: Non-HIV Patients Vs HIV Patients. Ocul Immunol Inflamm. 2020 May 18;28(4):651-658. doi: 10.1080/09273948.2019.1604003. Epub 2019 Jun 5. PMID: 31166809. Son G, Lee JY, Kim JG, Kim YJ. Clinical features of cytomegalovirus retinitis after solid organ transplantation versus hematopoietic stem cell transplantation. Graefes Arch Clin Exp Ophthalmol. 2021 Mar;259(3):585-591. doi: 10.1007/s00417-020-04871-w. Epub 2020 Aug 6. PMID: 32761472. Pathanapitoon K, Tesavibul N, Choopong P, et al. Clinical manifestations of cytomegalovirus-associated posterior uveitis and panuveitis in patients without human immunodeficiency virus infection. JAMA Ophthalmol. 2013 May;131(5):638-45. doi: 10.1001/jamaophthalmol 2013.2860. PMID: 23494002. Schneider EW, Elner SG, van Kuijk FJ, et al. Chronic retinal necrosis: cytomegalovirus necrotizing retinitis associated with panretinal vasculopathy in non-HIV patients. Retina. 2013 Oct;33(9):1791-9. doi: 10.1097/IAE.0b013e318285f486. PMID: 23584702. Alhawsawi AA, Aljahdali A, Magharbil E, et al. The Clinical Spectrum and Outcomes of Ocular Syphilis in Saudi Arabia: The Emergence of a Uveitic Masquerader. J Epidemiol Glob Health. 2025 Feb 24;15(1):31. doi: 10.1007/s44197-025-00374-1. PMID: 39994067; PMCID: PMC11850686. Standardization of Uveitis Nomenclature (SUN) Working Group. Classification Criteria for Cytomegalovirus Retinitis. Am J Ophthalmol. 2021 Aug;228:245-254. doi: 10.1016/j.ajo.2021.03.051. Epub 2021 May 11. PMID: 33845015; PMCID: PMC8594755. Du KF, Huang XJ, Chen C, et al. High Blood Cytomegalovirus Load Suggests Cytomegalovirus Retinitis in HIV/AIDS Patients: A Cross-Sectional Study. Ocul Immunol Inflamm. 2022 Oct-Nov;30(7-8):1559-1563. doi: 10.1080/09273948.2021.1905857. Epub 2021 Jun 14. PMID: 34125650. Deayton JR, Prof Sabin CA, Johnson MA, et al. Importance of cytomegalovirus viraemia in the risk of disease progression and death in HIV-infected patients receiving highly active antiretroviral therapy. Lancet. 2004 Jun 26;363(9427):2116-21. doi: 10.1016/S0140-6736(04)16500-8. PMID: 15220032. Kempen JH, Jabs DA, Dunn JP, et al. Retinal detachment risk in cytomegalovirus retinitis related to the acquired immunodeficiency syndrome. Arch Ophthalmol. 2001 Jan;119(1):33-40. PMID: 11146724. Magharbil E, Al-Qahtani F, Al-Enazi M, et al. Clinical findings, outcomes following management and complications of acute retinal necrosis: the experience of a tertiary eye centre in Saudi Arabia. J Ophthalmic Inflamm Infect. 2025 Jul 1;15(1):51. Doi: 10.1186/s12348-025-00511-8. PMID: 40591202; PMCID: PMC12214190. Kempen JH, Jabs DA, Wilson LA, et al. Risk of vision loss in patients with cytomegalovirus retinitis and the acquired immunodeficiency syndrome. Arch Ophthalmol. 2003 Apr;121(4):466-76. doi: 10.1001/archopht 121.4.466. PMID: 12695243. Jannadi R, Magliyah MS, Al Shalan H, et al. Neuroretinitis: Diagnostic Associations and Management Approach. Ocul Immunol Inflamm. 2025 May 22:1-8. Doi: 10.1080/09273948.2025.2508399. Epub ahead of print. PMID: 40401518. Tables Table 1 The clinical features of 12 eyes in 8 patients with cytomegalovirus retinitis Clinical Feature Number of eyes (%) Best-corrected visual acuity 0.8 ± 0.9 (Snellen = 20/125) Intraocular pressure 15.17 ± 4.5 mmHg Keratic precipitates Yes 3 (25) No 9 (75) Anterior chamber Quite 8 (66.7) Trace cells 3 (25) 1 + cells 1 (8.3) Lens Clear 9 (75) Posterior chamber intraocular lens 2 (16.7) Cataract 1 (8.3) Vitritis Yes 2 (16.7) No 11 (83.3) Type of retinitis Hemorrhagic 7 (58.3) Granular 5 (41.7) Extent of retinitis 2.8 ± 1.7 clock hours Area of retinitis Supero-nasal 6 (50) Infero-nasal 5 (41.7) Infero-temporal 5 (41.7) Superotemporal 2 (16.7) Zone of retinitis Zone I 5 (41.7) Zone II 9 (75.0) Zone III 6 (50.0) Optic disc involvement Yes 2 (16.7) No 10 (83.3) Macular Involvement Yes 3 (25) No 9 (75) Vasculitis Yes 3 (25) No 9 (75) Vascular occlusion Yes 2 (16.7) No 10 (83.3) Macular optical coherence tomography Normal 5 (41.7) Cystoid macular edema 2 (16.7) Atrophic 2 (16.7) Detached 1 (8.3) Not available 2 (16.7) Table 2 The comparisons between eyes of patients with HIV infections and eyes with other causes of immunosuppression. Feature Eyes with HIV (4) Eyes without HIV (8) Significance (95% CI) Odds Ratio (95% CI) Age 43.5 ± 9.4 years 51.0 ± 14.1 years P = 0.363 N/A Laterality Unilateral 2 Bilateral 2 Unilateral 2 Bilateral 6 P = 0.406 2.0 BCVA 0.58 ± 0.52 (20/80) 0.8 ± 1.0 (20/125) P = 0.640 N/A IOP 15.0 ± 5.5 15.3 ± 4.4 P = 0.933 N/A KPs Yes 0 No 4 Yes 3 No 5 P = 0.255 1.6 AC reaction Quite 3 Trace 1 1 + 0 Quite 5 Trace 2 1 + 1 P = 0.755 N/A Lens Clear 4 PCIOL 0 Cataract 0 Clear 5 PCIOL 2 Cataract 1 P = 0.368 N/A Vitritis No 4 Yes 0 No 7 Yes 2 P = 0.424 2.0 Macular involvement Yes 1 No 3 Yes 2 No 6 P = 0.764 1.0 Optic disc involvement Yes 1 No 3 Yes 1 No 7 P = 0.576 2.0 Vasculitis Yes 0 No 4 Yes 3 No 5 P = 0.255 2.7 Type of retinitis Hemorrhagic 2 Granular 2 Hemorrhagic 5 Granular 3 P = 0.576 0.8 Zone of retinitis Zone I 2 Zone II 4 Zone III 1 Zone I 3 Zone II 5 Zone III 5 P = 0.319 N/A Extension of retinitis 2.0 ± 3.0 clock hours 2.6 ± 1.7 clock hours P = 0.739 N/A Vascular occlusion Yes 0 No 4 Yes 2 No 6 P = 0.424 1.3 RRD Yes 2 No 2 Yes 1 No 7 P = 0.236 4.0 Glaucoma Yes 0 No 4 Yes 1 No 7 P = 0.667 1.1 Final outcome Good 2 Poor 2 Yes 4 No 4 P = 0.727 1.0 Final BCVA 1.4 ± 1.5 (20/500) 0.7 ± 1.0 (20/100) P = 0.365 N/A Final IOP 12.3 ± 6.9 mmHg 16.5 ± 3.7 mmHg P = 0.184 N/A AC: Anterior chamber; BCVA: best-corrected visual acuity; HIV: human immunodeficiency virus; IOP: intraocular pressure; KPs: keratic precipitates; PCIOL: Posterior chamber intraocular lens; RRD: rhegmatogenous retinal detachments Table 3 Analysis of several factors in relation to the final visual outcomes Factor Significance (95% CI) Odds Ratio (95% CI) Vitritis P = 0.773 1.0 Area of retinitis P = 0.716 N/A Zone of retinitis P = 0.284 N/A Extent of retinitis P = 0.285 N/A Optic disc involvement P = 0.773 1.0 Macular involvement P = 0.091 3.0 Vasculitis P = 0.500 1.5 Type of retinitis P = 0.500 1.4 Occlusive vasculitis P = 0.773 1.0 RRD P = 0.091 3.0 CI: confidence interval; N/A: not applicable; RRD: rhegmatogenous retinal detachment Additional Declarations No competing interests reported. Supplementary Files Supplementaryfigure1.jpg Supplementary figure 1: A is a color fundus photo of the left eye in a 73-year-old woman who developed cytomegalovirus (CMV) retinitis after renal transplantation, showing vitritis and supero-nasal granular retinitis. B is a color fundus photo of the left eye showing resolved retinitis and improved vitritis. Supplementaryfigure2.jpg Supplementary figure 2: A is a color fundus photo of the left eye in a 27-year-old woman after renal transplantation for lupus nephritis and developed CMV retinitis, showing superior and superotemporal hemorrhagic retinitis. B is a color fundus photo of the left eye showing resolved retinitis leaving atrophic retinal changes. Supplementaryfigure3.jpg Supplementary figure 3: A is a color fundus photo of the left eye in a 41-year-old man with severe congenital immunodeficiency and developed CMV retinitis showing diffuse hemorrhagic retinitis involving the macula and optic disc. B is a color fundus photo of the left eye showing a pale disc and an atrophic retina. Cite Share Download PDF Status: Published Journal Publication published 11 Mar, 2026 Read the published version in Journal of Ophthalmic Inflammation and Infection → Version 1 posted Editorial decision: Revision requested 13 Oct, 2025 Reviewers agreed at journal 16 Aug, 2025 Reviewers invited by journal 16 Aug, 2025 Editor assigned by journal 13 Aug, 2025 Submission checks completed at journal 13 Aug, 2025 First submitted to journal 12 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7358381","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":502198570,"identity":"89477da9-696b-473e-83ce-07d8c3e6b507","order_by":0,"name":"Abdulrahman AlZaid","email":"","orcid":"","institution":"King Khaled Eye Specialist Hospital","correspondingAuthor":false,"prefix":"","firstName":"Abdulrahman","middleName":"","lastName":"AlZaid","suffix":""},{"id":502198572,"identity":"fde0e8a8-e7cf-4980-b21e-552fd18af203","order_by":1,"name":"Abdulrahman Khan","email":"","orcid":"","institution":"King Khaled Eye Specialist Hospital","correspondingAuthor":false,"prefix":"","firstName":"Abdulrahman","middleName":"","lastName":"Khan","suffix":""},{"id":502198574,"identity":"b8edf927-2e93-4bd8-be18-8ab7d32d5f10","order_by":2,"name":"Hassan Al-Dhibi","email":"","orcid":"","institution":"King Khaled Eye Specialist Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hassan","middleName":"","lastName":"Al-Dhibi","suffix":""},{"id":502198577,"identity":"b8303d44-5441-426f-bc97-b498b4713652","order_by":3,"name":"Moustafa S. Magliyah","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAUlEQVRIiWNgGAWjYLCCBwYMDAbsbcxA5gEQ34CwlgSQFp5jJGkBKZNII1KL7rTDj18kFByWN5d8lmzw4c8dBt325g2MP2pwazG7nWZmkWBw2HDn7LTDiTPbnjGYnTlWwMxzDJ+WBDMDoBbGDbfTmw/zNhxmMLuRY8DMwIZPS/o3kBb7DTePNx/+8weo5f4bA8Yf//BpyTF+ANSSuOEG2+FkBjaQLTwGDLxteLWUAQM5PXnDmbRkw962wzxmZ9IKDvP24XXY5g8f/ljbbjh+zFjix5/DcmbHD298+OMbbi1AwCbBwNAM5/GAiAN4NTAwMH9gYKgjoGYUjIJRMApGNAAAPJNfEmWg/0cAAAAASUVORK5CYII=","orcid":"","institution":"King Khaled Eye Specialist Hospital","correspondingAuthor":true,"prefix":"","firstName":"Moustafa","middleName":"S.","lastName":"Magliyah","suffix":""}],"badges":[],"createdAt":"2025-08-12 18:08:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7358381/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7358381/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12348-026-00572-3","type":"published","date":"2026-03-11T15:59:43+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":89977649,"identity":"a55363c0-289f-4b31-8f20-1216baf8d516","added_by":"auto","created_at":"2025-08-27 06:10:43","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1015710,"visible":true,"origin":"","legend":"\u003cp\u003eA is a color fundus photo of the right eye in a 56-year-old man who developed cytomegalovirus (CMV) retinitis after renal transplantation, showing multiple areas of focal hemorrhagic retinitis in the macula and superonasally, along with diffuse atrophic retinal changes and macular edema. B is a color fundus photo of the left eye showing 1+ vitritis and diffuse retinitis infero-temporally and infero-nasally. C is a color fundus photo of the left eye showing rhegmatogenous retinal detachment (RRD). D is a color fundus photo showing a flat retina after surgical repair with silicone oil reflections. E is a spectral domain optical coherence tomography (SD-OCT) photo of the left eye showing a detached macula. F is an SD-OCT showing a flat macula with atrophic changes and epiretinal membrane formation.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7358381/v1/67d73bc59453b000ae40d8cf.jpg"},{"id":89977653,"identity":"1c598514-89f8-455a-9807-0b73e1f21202","added_by":"auto","created_at":"2025-08-27 06:10:43","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":703086,"visible":true,"origin":"","legend":"\u003cp\u003eA is a color photo of the right eye in a 30-year-old man with human immunodeficiency virus (HIV) infection and developed CMV retinitis showing focal hemorrhagic retinitis nasally. B is a color photo of the right eye showing progression of retinitis to involve the supero-nasal, inferonasal, and inferior retina. C is a color photo of the right eye showing progression of retinitis with optic disc involvement. D is a color photo of the right eye showing more progression and involvement of the optic disc and extension to the inferotemporal retina. E is a color photo of the right eye showing more proximal retinal involvement along with the optic disc involvement. F is a color photo of the right eye showing a total RRD, which was deemed inoperable.\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7358381/v1/430f00f157b0fe6fb2266e8a.jpg"},{"id":89977662,"identity":"bfc98151-32e4-4f68-a1fa-f2ec4bd35771","added_by":"auto","created_at":"2025-08-27 06:10:43","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":144830,"visible":true,"origin":"","legend":"\u003cp\u003eA is a color fundus photo of the left eye in a 44-year-old female with HIV infection and developed CMV retinitis showing hemorrhagic retinitis extending from the optic disc towards the nasal retina. B is a color fundus photo of the left eye showing consolidation of retinitis, leaving atrophic retinal changes nasally along with sclerosed blood vessels. C is a color fundus photo of the left eye showing marked improvement of retinitis and a healthy optic disc.\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7358381/v1/7a1d63b41efe64ee4728e289.jpg"},{"id":104740381,"identity":"f401413a-624e-4758-9100-ff194971f694","added_by":"auto","created_at":"2026-03-16 16:17:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2519285,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7358381/v1/30a202ea-c61d-4db0-9607-1a5f926675ae.pdf"},{"id":89977651,"identity":"83016ffa-df29-4655-bbbc-14bc5a30eb10","added_by":"auto","created_at":"2025-08-27 06:10:43","extension":"jpg","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":225803,"visible":true,"origin":"","legend":"\u003cp\u003eSupplementary figure 1: A is a color fundus photo of the left eye in a 73-year-old woman who developed cytomegalovirus (CMV) retinitis after renal transplantation, showing vitritis and supero-nasal granular retinitis. B is a color fundus photo of the left eye showing resolved retinitis and improved vitritis.\u003c/p\u003e","description":"","filename":"Supplementaryfigure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7358381/v1/0c76ac1f2e3812e7f392d513.jpg"},{"id":89977652,"identity":"13cf5e4a-caa1-493b-8ecd-39ad500310b7","added_by":"auto","created_at":"2025-08-27 06:10:43","extension":"jpg","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":228876,"visible":true,"origin":"","legend":"\u003cp\u003eSupplementary figure 2: A is a color fundus photo of the left eye in a 27-year-old woman after renal transplantation for lupus nephritis and developed CMV retinitis, showing superior and superotemporal hemorrhagic retinitis. B is a color fundus photo of the left eye showing resolved retinitis leaving atrophic retinal changes.\u003c/p\u003e","description":"","filename":"Supplementaryfigure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7358381/v1/0c7c6c8af4652d2fba30770b.jpg"},{"id":89977654,"identity":"f9d7da0b-eca7-47b2-a63e-8af58b991050","added_by":"auto","created_at":"2025-08-27 06:10:43","extension":"jpg","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":353778,"visible":true,"origin":"","legend":"\u003cp\u003eSupplementary figure 3: A is a color fundus photo of the left eye in a 41-year-old man with severe congenital immunodeficiency and developed CMV retinitis showing diffuse hemorrhagic retinitis involving the macula and optic disc. B is a color fundus photo of the left eye showing a pale disc and an atrophic retina.\u003c/p\u003e","description":"","filename":"Supplementaryfigure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7358381/v1/f7bd6d7d748b80b03395444b.jpg"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eCMV Retinitis: The Diagnostic Challenges and Long-Term Outcomes. The Experience of Tertiary Eye Center in Saudi Arabia\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCytomegalovirus (CMV) is an opportunistic virus that belongs to the Herpesviridae family, which are double-stranded DNA viruses that vary in size between 120 and 160 nm. CMV has a prevalence of about 50\u0026ndash;88% in the general population [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. CMV retinitis is a clinical term which describes the reactivation of the CMV leading to prominent retinal inflammation in the absence of anterior chamber reaction or vitritis as a result of compromised immune status [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Before the era of human immunodeficiency virus (HIV), CMV retinitis was observed mainly in iatrogenically immunosuppressed patients, including transplant recipients and patients receiving chemotherapy [\u003cspan additionalcitationids=\"CR4 CR5 CR6\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. After the emergence of HIV, CMV retinitis was commonly found in patients with HIV infection and low CD4 counts [\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In addition, patients who have undergone organ transplantations are predisposed to CMV retinitis [\u003cspan additionalcitationids=\"CR12 CR13 CR14 CR15\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The development of Highly Active Antiretroviral Therapy (HAART), which controls the replication of HIV and induces immune restoration, in addition to the advances in the immunosuppressive treatment options after organ transplantation, allowed for a better understanding of the clinical picture and outcomes of CMV retinitis [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Two clinical pictures of CMV retinitis have been described: a fulminant picture that presents with confluent necrotizing retinitis and dispersed retinal hemorrhages, and an indolent picture characterized by a granular retinitis with few or absent hemorrhages. In a previous study, which compared the clinical pictures of CMV retinitis in HIV infected and non-HIV-infected patients, the presence of vitritis, vasculitis, and vascular occlusion was more commonly found in non-HIV patients [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. However, with the emergence of infectious diseases that are usually seen with compromised immune status in the Middle East and Gulf regions, more data about the clinical pictures and outcomes of these diseases are needed [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In this paper, we aim to describe the clinical pictures and long-term outcomes of CMV retinitis in patients with and without HIV infections presenting to a tertiary eye center.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis is a retrospective interventional cohort study that included all patients who presented with a clinical picture suggestive of CMV retinitis and had their diagnosis confirmed by polymerase chain reaction (PCR) testing. This study was approved by the Institutional Review Board (IRB) at King Khaled Eye Specialist Hospital (KKESH) with IRB number 25133-R, and the study adhered to the tenets of the Declaration of Helsinki. The electronic files at KKESH were searched for the terms (cytomegalovirus retinitis) and (CMV retinitis) to search for cases from 2014 to 2024. Cases of acute retinal necrosis (ARN), ocular syphilis disease, and cases that were not confirmed by PCR testing were excluded. The diagnosis of CMV retinitis was based on the classification criteria of CMV retinitis approved by the Executive Committee of the Standardization of Uveitis Nomenclature (SUN) Working Group in 2021 [\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e], which include the following criteria:\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e1. Necrotizing retinitis with indistinct borders due to numerous small satellites.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e2. Evidence of immune compromise.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e3. Either a characteristic clinical appearance or positive polymerase chain reaction assay results for CMV from an intraocular specimen.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eA detailed review of the electronic records of all included patients was performed, including detailed immunological history, ophthalmic examination on presentation, PCR test results, systemic and ocular treatments, ocular complications, and final visual outcomes. Multimodal retinal imaging, including fundus photography (Optos PLC, Dunfermline, UK) and spectral domain optical coherence tomography (SD-OCT; Spectralis, Heidelberg engineering, Hiedlberg, Germany), was performed. The data were analyzed using IBM SPSS Statistics version 26.0 (IBM, Armonk, NY, USA). Frequencies and percentages were computed to describe categorical data. Means with standard deviations were computed to describe continuous data. Chi-squared test was used to compare categorical data, and analysis of variance (ANOVA) was used for comparison of numerical data. A P-value of \u0026lt;\u0026thinsp;0.05 at 95% confidence interval (CI) was considered significant. Whenever possible, the odds ratio was calculated at 95% CI to analyze the risks.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eTwelve eyes of 8 patients were included. Five patients (62.5%) were males and 3 (37.5%) were females. All patients were immunosuppressed for 9.2\u0026thinsp;\u0026plusmn;\u0026thinsp;6.9 years. Four patients (40%) were on immunosuppressive medications after renal transplantations for chronic renal failure (CRF). The reasons for CRF were uncontrolled diabetes and hypertension in 3 patients and lupus nephritis in one patient. One patient had a congenital immunodeficiency disease, and three patients had human immunodeficiency virus (HIV) infections. Three patients were on oral prednisolone, and one patient was on Tacrolimus. Four patients (50%) had bilateral involvement, and 4 patients had unilateral involvement. Five eyes (41.7%) were right eyes, and 7 eyes (58.3%) were left eyes. The baseline best-corrected visual acuity (BCVA) was 0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9 (Snellen\u0026thinsp;=\u0026thinsp;20/125). Vitritis (Supplementary Fig.\u0026nbsp;1) was found only in 2 eyes (16.7%). Seven eyes (58.3%) had a hemorrhagic type of retinitis (Supplementary Fig.\u0026nbsp;2), and 5 eyes had granular retinitis (41.7%). Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the clinical examination details of the 12 eyes included in the study. All eyes had positive polymerase chain reaction (PCR) tests for CMV from aqueous samples. All patients were treated with oral valganciclovir 900 mg twice daily for 21 days, followed by once daily. The total duration of treatment with oral valganciclovir was 5.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2 months. Five eyes (41.7%) were treated with intravitreal ganciclovir with an average of 6.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5 injections. All three patients with HIV infections were treated with Highly Active Antiretroviral Therapy (HAART). Optic nerve involvement was observed in two eyes on presentation. In one eye, it was an early involvement which was improved with treatment and resulted in 20/60 vision, while optic involvement was extensive and resulted in total optic disc pallor and no light perception (NLP) vision in one eye (Supplementary Fig.\u0026nbsp;3). Rhegmatogenous retinal detachment (RRD) developed in 3 eyes (25%), 2 eyes of HIV patients, and one eye of a post-renal transplantation patient on immunosuppressive medications. Two RRDs had surgical repairs with pars plana vitrectomy, endolaser, and silicone oil (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). One of the operated eyes developed neovascular glaucoma (NVG) and was treated with Ahmed Glaucoma valve (AGV) implantation. One eye in an HIV patient who was not compliant with HAART treatment had progressive retinitis, which later involved the optic nerve and resulted in an RRD that was deemed inoperable (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). In addition, the central nervous system was later involved, and the patient developed encephalitis and ependymitis. Total resolution of retinitis without visual threatening complications was achieved in 6 eyes (50%), including one eye which had an early optic disc involvement (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). There were no significant differences between eyes that had HIV infections and eyes that did not have HIV infections. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the comparisons between the eyes of patients with HIV infections and eyes with other causes of immunosuppression. The mean BCVA on the last visit was 0.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2 (Snellen\u0026thinsp;=\u0026thinsp;20/160), and the mean IOP was 15.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1 mmHg. The change in BCVA was statistically significant (P\u0026thinsp;=\u0026thinsp;0.027). There were marginally insignificant relationships between macular involvement of retinitis (P\u0026thinsp;=\u0026thinsp;0.091, OR\u0026thinsp;=\u0026thinsp;3.0) and the incidence of RRD (P\u0026thinsp;=\u0026thinsp;0.091, OR\u0026thinsp;=\u0026thinsp;3.0) with poor visual outcomes. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the relationship analysis between several factors and poor visual outcomes.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this paper, we describe the clinical features and management outcomes of CMV retinitis in a tertiary eye center. In the HIV era, care needs to be taken not to misdiagnose or delay the diagnosis of this vision-threatening disease [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Previous studies suggested that, unlike HIV infected patients, the clinical picture of CMV retinitis in non-HIV retinitis patients more commonly involves vitritis, vasculitis, and occlusive vasculitis, leaning towards the clinical picture of acute retinal necrosis (ARN) commonly caused by herpes simplex and herpes zoster viruses [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. This study also shows that vitritis and vasculitis were found in the non-HIV subset of patients and were absent in HIV infected patients. This might be related to the fact that CMV can potentiate the pathogenicity of HIV by activating HIV, increasing the intracellular transport of HIV, and affecting CD8 T cell function. CMV also increases HIV viral replication, further decreasing the immunity of the hosts [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. On the other hand, some reports suggested that patients with non-HIV infection-related CMV retinitis had quiet eyes with absence of vitritis and anterior chamber reactions [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn our experience, we found that the term (non-HIV) is a generalized term that lumps multiple causes of immunocompromise together. Patients who had renal transplantations in this series developed vitritis and anterior chamber reactions, while vasculitis was present in a patient who had renal transplantation and a patient who had a severe congenital immune deficiency and ended up with occlusive vasculitis in the latter patient. Notably, patients with non-HIV-infected CMV retinitis presented with lower visual acuity, larger extent of retinitis, and a higher risk of macular involvement. These findings were similar to previous findings in these patients [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, there was less zone I retinitis involvement and incidence of vasculitis. These differences might be explained by the heterogeneity of the causes of compromised immunity in these patients.\u003c/p\u003e\u003cp\u003eThe overall incidence of RRD in our patients was 25% and was slightly higher among patients with HIV-related CMV retinitis. This is slightly higher than previously reported rates of RRD in CMV retinitis and might be explained by the larger extent of retinitis leading to RRD [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The higher risk of RRD in eyes with a larger extent of retinitis was also found in ARN and was more commonly seen in eyes with multifocal or diffuse retinitis [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. However, unlike ARN, which had an increased risk of RRD with higher grades of vitritis, RRD in CMV retinitis was not related to vitritis [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. This might be explained by the low grades of vitritis in CMV retinitis, which result in minimal inflammatory changes that contribute to the mechanism of RRD. Nevertheless, the inflammatory component in RRD formation is an important contributor, as the risk of RRD in ARN eyes is much higher (56%) than in eyes with CMV retinitis.\u003c/p\u003e\u003cp\u003eOther complications that affected visual outcomes in this study include retinal atrophic changes from proximal involvement of retinitis, optic nerve involvement, and neovascular glaucoma (NVG). Previous studies have also reported these complications in CMV retinitis [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. NVG is thought to be caused by peripheral retinal ischemia induced by a large area of retinitis.16 In our study, one eye had NVG after undergoing a surgical repair for RRD in which laser was applied to the areas of retinitis, indicating that retinal ischemia is not limited to and does not correspond to the area of retinitis. Appropriate and timely laser photocoagulation application to the ischemic retina helps avoid the ischemia-related complications of NVG and vitreous hemorrhage.\u003c/p\u003e\u003cp\u003eOptic nerve involvement was observed in 2 eyes of 2 patients: One HIV infected patient and one with severe congenital immunodeficiency, resulting in total optic disc pallor in one eye and good visual recovery in response to HAART and systemic and local treatment in one eye. The importance of early recognition of optic disc involvement in CMV retinitis cannot be overemphasized. Another condition that needs to be differentiated from optic nerve involvement in CMV retinitis is neuroretinitis, either infectious or non-infectious. In addition to the classical picture of hemorrhagic or granular retinitis of CMV infection, neuroretinitis usually involves more prominent vitreous involvement in the form of prepapillary vitreous opacities in non-infectious neuroretinitis and higher grades of focal or diffuse vitritis in toxoplasmosis-related neuroretinitis and macular exudation in cat-scratch disease [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMacular involvement was noted in 3 eyes and affected the visual outcomes. Poor visual outcomes as a result of macular involvement were also observed in previous studies [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The reason for these outcomes is the retinal atrophic changes, which persist even after the administration of proper treatments.\u003c/p\u003e\u003cp\u003eAll of our patients were treated with Valganciclovir, and intravitreal ganciclovir was administered to 41% of eyes in our patients. The reasons for not giving intravitreal injections in the remaining eyes included patient refusal, limited availability, and total visual loss beyond salvation. In addition, HAART constitutes an integral part of management in patients infected with HIV. The non-compliance with the treatment in one patient resulted in more extensive CMV retinitis and eventually inoperable RRD, leading to total visual loss as the other eye was lost before presentation.\u003c/p\u003e\u003cp\u003eThis study has several limitations, including the retrospective nature, the differences in clinical assessments, investigations, and treatment regimens between the treating physicians, and small patient numbers. Importantly, there are several factors that contributed to the limited number of patients. These factors include patient-related social and cultural barriers, limited access to tertiary eye care for patients who are debilitated or severely immunocompromised, and the loss to follow-up in some patients, preventing the assessment of treatment efficacy. Despite these limitations, the current study provides real-world data regarding the clinical features of patients with and without HIV infection in a region where data about this disease are lacking, and adds to the body of evidence on long-term outcomes of CMV retinitis.\u003c/p\u003e\u003cp\u003eIn conclusion, the clinical features of CMV retinitis are more accurately related to the level of immunity than to the classification of HIV vs non-HIV CMV retinitis. The absence of vitritis, vasculitis, and occlusive vasculitis is an important feature of HIV-related CMV retinitis. This indicates an absence of inflammatory reaction and an inability to fight the opportunistic viral infection. Timely recognition and appropriate treatment are critical to achieve better long-term visual recovery and avoid vision-threatening complications like RRD, macular atrophy, optic nerve involvement, and NVG.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval:\u0026nbsp;\u003c/strong\u003eThis study adhered to the tenets of the declaration of Helsinki at 1964 and its amendments. The study was approved by the Institutional review board (IRB) at King Khaled Eye Specialist Hospital (KKESH), IRB number: RP 22013-R.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e: AA, AK, HA and MM: conceptualization and design; data acquisition, analysis, and interpretation and drafting the manuscript. AA and AK: conceptualization and design; HA and MM: critically revising the manuscript. The final version of the manuscript was approved by all authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate:\u0026nbsp;\u003c/strong\u003eInformed consents were obtained from all participants included in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication:\u0026nbsp;\u003c/strong\u003eInformed consents were obtained from all participants to publish the study material.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability:\u003c/strong\u003e All data generated or analyzed during this study are included in this article. Further enquiries can be directed to the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u003c/strong\u003e None of the authors have any conflict of interest to disclose. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial (such as honoraria; educational grants; participation in speakers\u0026rsquo; bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: None for each author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure of interest\u003c/strong\u003e: The authors report there are no competing interests to declare\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eJabs DA. Cytomegalovirus retinitis and the acquired immunodeficiency syndrome\u0026ndash;bench to bedside: LXVII Edward Jackson Memorial Lecture. Am J Ophthalmol. 2011;151(2):198\u0026ndash;216. e191. doi:10.1016/j.ajo.2010.10.018.\u003c/li\u003e\n\u003cli\u003eBakir TM. Prevalence of antibodies to herpesviruses in central Saudi Arabia. Ann Saudi Med 1987;7:196‑201. https://doi.org/10.5144/0256-4947.1987.196.\u003c/li\u003e\n\u003cli\u003eMurray HW, Knox DL, Green WR, Susel RM. Cytomegalovirus in adults. Am J Med 1977;63:574\u0026ndash;584.\u003c/li\u003e\n\u003cli\u003eCoskuncan JM, Jabs DA, Dunn JP, et al. The eye in bone marrow transplantation: retinal complications. Arch Ophthalmol 1994;112:372 379.\u003c/li\u003e\n\u003cli\u003eEgbert PR, Pollard RB, Gallagher JG, Merigan TC. Cytomegalovirus retinitis in immunosuppressed hosts: ocular manifestations. Ann Intern Med 1980;93:664\u0026ndash;670.\u003c/li\u003e\n\u003cli\u003eJabs DA, Wingard JR, de Bustros S, et al. B759U for cytomegalovirus retinitis: intraocular drug penetration. Arch Ophthalmol 1986;104:1436\u0026ndash;1437.\u003c/li\u003e\n\u003cli\u003eMaguire AM, Nichols CW, Crooks GW. Visual loss in cytomegalovirus retinitis caused by cystoid macular edema in patients without acquired immune deficiency syndrome. Ophthalmol 1996;103:601\u0026ndash;605.\u003c/li\u003e\n\u003cli\u003eHolland GN, Vaudaux JD, Jeng SM, et al. Characteristics of untreated AIDS-related cytomegalovirus retinitis. I. Findings before the era of highly active antiretroviral therapy (1988 to 1994). Am J Ophthalmol. 2008 Jan;145(1):5-11. doi: 10.1016/j.ajo.2007.09.023. PMID: 18154750.\u003c/li\u003e\n\u003cli\u003eHolland GN, Vaudaux JD, Shiramizu KM, et al. Characteristics of untreated AIDS-related cytomegalovirus retinitis. II. Findings in the era of highly active antiretroviral therapy (1997 to 2000). Am J Ophthalmol. 2008 Jan;145(1):12-22. doi: 10.1016/j.ajo.2007.09.040. PMID: 18154751.\u003c/li\u003e\n\u003cli\u003eAgrawal R, Gunasekeran DV, Xu Y, et al. Clinical Features and CD4+ T Cell Count in AIDS Patients with CMV Retinitis: Correlation with Mortality. Ocul Immunol Inflamm. 2022 Jan 2;30(1):42-47. doi: 10.1080/09273948.2020.1772312. Epub 2020 Jul 9. PMID: 32644842.\u003c/li\u003e\n\u003cli\u003eKuo IC, Kempen JH, Dunn JP, Vogelsang G, Jabs DA. Clinical characteristics and outcomes of cytomegalovirus retinitis in persons without human immunodeficiency virus infection. Am J Ophthalmol. 2004 Sep;138(3):338-46. doi: 10.1016/j.ajo.2004.04.015. PMID: 15364214.\u003c/li\u003e\n\u003cli\u003eIu LP, Fan MC, Lau JK, et al. Long-term Follow-up of Cytomegalovirus Retinitis in Non-HIV Immunocompromised Patients: Clinical Features and Visual Prognosis. Am J Ophthalmol. 2016 May;165:145-53. doi: 10.1016/j.ajo.2016.03.015. Epub 2016 Mar 19. PMID: 27005706.\u003c/li\u003e\n\u003cli\u003eHo M, Invernizzi A, Zagora S, Tsui J, Oldani M, Lui G, McCluskey P, Young AL. Presenting Features, Treatment, and Clinical Outcomes of Cytomegalovirus Retinitis: Non-HIV Patients Vs HIV Patients. Ocul Immunol Inflamm. 2020 May 18;28(4):651-658. doi: 10.1080/09273948.2019.1604003. Epub 2019 Jun 5. PMID: 31166809.\u003c/li\u003e\n\u003cli\u003eSon G, Lee JY, Kim JG, Kim YJ. Clinical features of cytomegalovirus retinitis after solid organ transplantation versus hematopoietic stem cell transplantation. Graefes Arch Clin Exp Ophthalmol. 2021 Mar;259(3):585-591. doi: 10.1007/s00417-020-04871-w. Epub 2020 Aug 6. PMID: 32761472.\u003c/li\u003e\n\u003cli\u003ePathanapitoon K, Tesavibul N, Choopong P, et al. Clinical manifestations of cytomegalovirus-associated posterior uveitis and panuveitis in patients without human immunodeficiency virus infection. JAMA Ophthalmol. 2013 May;131(5):638-45. doi: 10.1001/jamaophthalmol 2013.2860. PMID: 23494002.\u003c/li\u003e\n\u003cli\u003eSchneider EW, Elner SG, van Kuijk FJ, et al. Chronic retinal necrosis: cytomegalovirus necrotizing retinitis associated with panretinal vasculopathy in non-HIV patients. Retina. 2013 Oct;33(9):1791-9. doi: 10.1097/IAE.0b013e318285f486. PMID: 23584702.\u003c/li\u003e\n\u003cli\u003eAlhawsawi AA, Aljahdali A, Magharbil E, et al. The Clinical Spectrum and Outcomes of Ocular Syphilis in Saudi Arabia: The Emergence of a Uveitic Masquerader. J Epidemiol Glob Health. 2025 Feb 24;15(1):31. doi: 10.1007/s44197-025-00374-1. PMID: 39994067; PMCID: PMC11850686.\u003c/li\u003e\n\u003cli\u003eStandardization of Uveitis Nomenclature (SUN) Working Group. Classification Criteria for Cytomegalovirus Retinitis. Am J Ophthalmol. 2021 Aug;228:245-254. doi: 10.1016/j.ajo.2021.03.051. Epub 2021 May 11. PMID: 33845015; PMCID: PMC8594755.\u003c/li\u003e\n\u003cli\u003eDu KF, Huang XJ, Chen C, et al. High Blood Cytomegalovirus Load Suggests Cytomegalovirus Retinitis in HIV/AIDS Patients: A Cross-Sectional Study. Ocul Immunol Inflamm. 2022 Oct-Nov;30(7-8):1559-1563. doi: 10.1080/09273948.2021.1905857. Epub 2021 Jun 14. PMID: 34125650.\u003c/li\u003e\n\u003cli\u003eDeayton JR, Prof Sabin CA, Johnson MA, et al. Importance of cytomegalovirus viraemia in the risk of disease progression and death in HIV-infected patients receiving highly active antiretroviral therapy. Lancet. 2004 Jun 26;363(9427):2116-21. doi: 10.1016/S0140-6736(04)16500-8. PMID: 15220032.\u003c/li\u003e\n\u003cli\u003eKempen JH, Jabs DA, Dunn JP, et al. Retinal detachment risk in cytomegalovirus retinitis related to the acquired immunodeficiency syndrome. Arch Ophthalmol. 2001 Jan;119(1):33-40. PMID: 11146724.\u003c/li\u003e\n\u003cli\u003eMagharbil E, Al-Qahtani F, Al-Enazi M, et al. Clinical findings, outcomes following management and complications of acute retinal necrosis: the experience of a tertiary eye centre in Saudi Arabia. J Ophthalmic Inflamm Infect. 2025 Jul 1;15(1):51. Doi: 10.1186/s12348-025-00511-8. PMID: 40591202; PMCID: PMC12214190.\u003c/li\u003e\n\u003cli\u003eKempen JH, Jabs DA, Wilson LA, et al. Risk of vision loss in patients with cytomegalovirus retinitis and the acquired immunodeficiency syndrome. Arch Ophthalmol. 2003 Apr;121(4):466-76. doi: 10.1001/archopht 121.4.466. PMID: 12695243.\u003c/li\u003e\n\u003cli\u003eJannadi R, Magliyah MS, Al Shalan H, et al. Neuroretinitis: Diagnostic Associations and Management Approach. Ocul Immunol Inflamm. 2025 May 22:1-8. Doi: 10.1080/09273948.2025.2508399. Epub ahead of print. PMID: 40401518.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe clinical features of 12 eyes in 8 patients with cytomegalovirus retinitis\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClinical Feature\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber of eyes (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBest-corrected visual acuity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9 (Snellen\u0026thinsp;=\u0026thinsp;20/125)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntraocular pressure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15.17\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5 mmHg\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKeratic precipitates\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes 3 (25)\u003c/p\u003e\u003cp\u003eNo 9 (75)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnterior chamber\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eQuite 8 (66.7)\u003c/p\u003e\u003cp\u003eTrace cells 3 (25)\u003c/p\u003e\u003cp\u003e1\u0026thinsp;+\u0026thinsp;cells 1 (8.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLens\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eClear 9 (75)\u003c/p\u003e\u003cp\u003ePosterior chamber intraocular lens 2 (16.7)\u003c/p\u003e\u003cp\u003eCataract 1 (8.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVitritis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes 2 (16.7)\u003c/p\u003e\u003cp\u003eNo 11 (83.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eType of retinitis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHemorrhagic 7 (58.3)\u003c/p\u003e\u003cp\u003eGranular 5 (41.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExtent of retinitis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7 clock hours\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eArea of retinitis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSupero-nasal 6 (50)\u003c/p\u003e\u003cp\u003eInfero-nasal 5 (41.7)\u003c/p\u003e\u003cp\u003eInfero-temporal 5 (41.7)\u003c/p\u003e\u003cp\u003eSuperotemporal 2 (16.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eZone of retinitis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eZone I 5 (41.7)\u003c/p\u003e\u003cp\u003eZone II 9 (75.0)\u003c/p\u003e\u003cp\u003eZone III 6 (50.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOptic disc involvement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes 2 (16.7)\u003c/p\u003e\u003cp\u003eNo 10 (83.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMacular Involvement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes 3 (25)\u003c/p\u003e\u003cp\u003eNo 9 (75)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVasculitis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes 3 (25)\u003c/p\u003e\u003cp\u003eNo 9 (75)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVascular occlusion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes 2 (16.7)\u003c/p\u003e\u003cp\u003eNo 10 (83.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMacular optical coherence tomography\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNormal 5 (41.7)\u003c/p\u003e\u003cp\u003eCystoid macular edema 2 (16.7)\u003c/p\u003e\u003cp\u003eAtrophic 2 (16.7)\u003c/p\u003e\u003cp\u003eDetached 1 (8.3)\u003c/p\u003e\u003cp\u003eNot available 2 (16.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe comparisons between eyes of patients with HIV infections and eyes with other causes of immunosuppression.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFeature\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEyes with HIV (4)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEyes without HIV (8)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSignificance (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eOdds Ratio (95% CI)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43.5\u0026thinsp;\u0026plusmn;\u0026thinsp;9.4 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51.0\u0026thinsp;\u0026plusmn;\u0026thinsp;14.1 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.363\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLaterality\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnilateral 2\u003c/p\u003e\u003cp\u003eBilateral 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eUnilateral 2\u003c/p\u003e\u003cp\u003eBilateral 6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.406\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBCVA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52 (20/80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0 (20/125)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.640\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIOP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.933\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKPs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes 0\u003c/p\u003e\u003cp\u003eNo 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes 3\u003c/p\u003e\u003cp\u003eNo 5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.255\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAC reaction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eQuite 3\u003c/p\u003e\u003cp\u003eTrace 1\u003c/p\u003e\u003cp\u003e1\u0026thinsp;+\u0026thinsp;0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eQuite 5\u003c/p\u003e\u003cp\u003eTrace 2\u003c/p\u003e\u003cp\u003e1\u0026thinsp;+\u0026thinsp;1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.755\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLens\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eClear 4\u003c/p\u003e\u003cp\u003ePCIOL 0\u003c/p\u003e\u003cp\u003eCataract 0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eClear 5\u003c/p\u003e\u003cp\u003ePCIOL 2\u003c/p\u003e\u003cp\u003eCataract 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.368\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVitritis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo 4\u003c/p\u003e\u003cp\u003eYes 0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo 7\u003c/p\u003e\u003cp\u003eYes 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.424\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMacular involvement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes 1\u003c/p\u003e\u003cp\u003eNo 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes 2\u003c/p\u003e\u003cp\u003eNo 6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.764\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOptic disc involvement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes 1\u003c/p\u003e\u003cp\u003eNo 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes 1\u003c/p\u003e\u003cp\u003eNo 7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.576\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVasculitis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes 0\u003c/p\u003e\u003cp\u003eNo 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes 3\u003c/p\u003e\u003cp\u003eNo 5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.255\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eType of retinitis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHemorrhagic 2\u003c/p\u003e\u003cp\u003eGranular 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHemorrhagic 5\u003c/p\u003e\u003cp\u003eGranular 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.576\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eZone of retinitis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eZone I 2\u003c/p\u003e\u003cp\u003eZone II 4\u003c/p\u003e\u003cp\u003eZone III 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eZone I 3\u003c/p\u003e\u003cp\u003eZone II 5\u003c/p\u003e\u003cp\u003eZone III 5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.319\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExtension of retinitis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0 clock hours\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7 clock hours\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.739\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVascular occlusion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes 0\u003c/p\u003e\u003cp\u003eNo 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes 2\u003c/p\u003e\u003cp\u003eNo 6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.424\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRRD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes 2\u003c/p\u003e\u003cp\u003eNo 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes 1\u003c/p\u003e\u003cp\u003eNo 7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.236\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGlaucoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes 0\u003c/p\u003e\u003cp\u003eNo 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes 1\u003c/p\u003e\u003cp\u003eNo 7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.667\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFinal outcome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGood 2\u003c/p\u003e\u003cp\u003ePoor 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes 4\u003c/p\u003e\u003cp\u003eNo 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.727\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFinal BCVA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5 (20/500)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0 (20/100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.365\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFinal IOP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12.3\u0026thinsp;\u0026plusmn;\u0026thinsp;6.9 mmHg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7 mmHg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.184\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eAC: Anterior chamber; BCVA: best-corrected visual acuity; HIV: human immunodeficiency virus; IOP: intraocular pressure; KPs: keratic precipitates; PCIOL: Posterior chamber intraocular lens; RRD: rhegmatogenous retinal detachments\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAnalysis of several factors in relation to the final visual outcomes\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFactor\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSignificance (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOdds Ratio (95% CI)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVitritis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.773\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eArea of retinitis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.716\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eZone of retinitis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.284\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExtent of retinitis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.285\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOptic disc involvement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.773\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMacular involvement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.091\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVasculitis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.500\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eType of retinitis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.500\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOcclusive vasculitis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.773\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRRD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP\u0026thinsp;=\u0026thinsp;0.091\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003eCI: confidence interval; N/A: not applicable; RRD: rhegmatogenous retinal detachment\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-ophthalmic-inflammation-and-infection","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"joii","sideBox":"Learn more about [Journal of Ophthalmic Inflammation and Infection](http://joii-journal.springeropen.com)","snPcode":"12348","submissionUrl":"https://submission.nature.com/new-submission/12348/3","title":"Journal of Ophthalmic Inflammation and Infection","twitterHandle":"@SpringerOpen","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"CMV retinitis, HIV, retinal detachment, Valganciclovir, immunocompromised status","lastPublishedDoi":"10.21203/rs.3.rs-7358381/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7358381/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e\u003cp\u003eTo describe the clinical features, complications, and long-term visual outcomes of cytomegalovirus (CMV) retinitis in patients presenting to a tertiary eye center.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA retrospective chart review of patients who were diagnosed with CMV retinitis between 2014 and 2024.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eTwelve eyes of 8 patients were included. Five patients (62.5%) were males and 3 (37.5%) were females. All patients were immunocompromised. Four patients (40%) were on immunosuppressive medications after renal transplantations for chronic renal failure (CRF), three patients had human immunodeficiency virus (HIV) infections, and one patient had a congenital immunodeficiency disease. The baseline best-corrected visual acuity (BCVA) was 0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9 (Snellen\u0026thinsp;=\u0026thinsp;20/125). Seven eyes (58.3%) had a hemorrhagic type of retinitis, and 5 eyes had granular retinitis (41.7%). Vitritis was found only in 2 eyes (16.7%), vasculitis was found in 3 eyes (25%), and occlusive vasculitis was found in 2 eyes (16.7%), and all of these features were present in patients who were non-HIV infected. The mean BCVA on the last visit was 0.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2 (Snellen\u0026thinsp;=\u0026thinsp;20/160). Visual threatening complications included macular atrophy, optic disc pallor, rhegmatogenous retinal detachment (RRD), and NVG.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe clinical picture of CMV retinitis is better related to the level of immunity than the classification of HIV vs non-HIV related. Signs of inflammatory response were absent in HIV-infected patients.\u003c/p\u003e","manuscriptTitle":"CMV Retinitis: The Diagnostic Challenges and Long-Term Outcomes. The Experience of Tertiary Eye Center in Saudi Arabia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-27 06:10:38","doi":"10.21203/rs.3.rs-7358381/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-13T08:33:36+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"322533421371318716140458507303166042271","date":"2025-08-16T15:39:34+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-16T10:00:39+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-13T07:41:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-13T07:41:34+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Ophthalmic Inflammation and Infection","date":"2025-08-12T17:52:15+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-ophthalmic-inflammation-and-infection","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"joii","sideBox":"Learn more about [Journal of Ophthalmic Inflammation and Infection](http://joii-journal.springeropen.com)","snPcode":"12348","submissionUrl":"https://submission.nature.com/new-submission/12348/3","title":"Journal of Ophthalmic Inflammation and Infection","twitterHandle":"@SpringerOpen","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"820407df-0766-4683-b859-1fc4dc8182df","owner":[],"postedDate":"August 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-16T16:13:39+00:00","versionOfRecord":{"articleIdentity":"rs-7358381","link":"https://doi.org/10.1186/s12348-026-00572-3","journal":{"identity":"journal-of-ophthalmic-inflammation-and-infection","isVorOnly":false,"title":"Journal of Ophthalmic Inflammation and Infection"},"publishedOn":"2026-03-11 15:59:43","publishedOnDateReadable":"March 11th, 2026"},"versionCreatedAt":"2025-08-27 06:10:38","video":"","vorDoi":"10.1186/s12348-026-00572-3","vorDoiUrl":"https://doi.org/10.1186/s12348-026-00572-3","workflowStages":[]},"version":"v1","identity":"rs-7358381","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7358381","identity":"rs-7358381","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}