Do we need separate screening strategies for cytomegalovirus retinitis in different underlying immunosuppressed states? A retrospective study from Western India

Abstract

Purpose: The aim of this study was to describe the clinical features, course, and clinical outcomes of eyes with cytomegalovirus (CMV) retinitis in immunosuppressed patients of different etiologies.

Methods: This was a retrospective observational study from a single ophthalmic tertiary care center. The patients included referrals from the nodal cancer center and the local human immunodeficiency virus (HIV) treatment clinic. Demographics, history, visual acuity, ocular features, treatment protocol, and final visual outcome of patients who were diagnosed with CMV retinitis in the period of five years from 2014 to 2019 were studied.

Results: CMV retinitis was diagnosed in 25 eyes of 14 patients. Age of the patients ranged from 11-54 years. Ten (71.43%) patients were male and four (29.57%) were female. Eight of them had acute lymphoblastic leukemia (ALL), four were suffering from HIV infection and one patient each had lymphoma and history of a kidney transplant. The treatment for CMV retinitis ranged from two to sixty weeks depending on disease activity and systemic condition. Three of the patients were on maintenance therapy for ALL at the time of reactivation.

Conclusion: Duration of treatment for CMV retinitis in patients of ALL was longer as compared to the other etiologies, and in recurrences, it needed to be continued till the completion of maintenance therapy for ALL. It is prudent to advise regular ophthalmic screening of all immunocompromised patients, as they are at a high risk of developing CMV retinitis. Patients of ALL, especially while on maintenance therapy, should be monitored for possible development or reactivation of CMV retinitis.

Keywords: Cytomegalovirus; Leukemia; Retinitis.

Figure 1

17 years old female with history of ALL (a) Left eye fundus shows presence of white retinal infiltrates along the vessels with interspersed retinal haemorrhages and florid optic disc edema. (b) Left eye of the same patient showing resolving lesions post intravenous ganciclovir

Figure 2

Sequelae of CMV retinitis in a 12 years old girl suffering from T cell Acute Lymphocytic Leukemia (ALL). (a) OD maintained good vision as the macula was spared with healed lesions in the periphery (b) OS denied PL with presence of healed scarred retinitis involving macula; also note the pale disc

Figure 3

13 years old boy with history of ALL. (a and b) Both eyes show active CMV retinitis with white infiltrates. (c and d) Same patient after 4 weeks of intravenous ganciclovir treatment with both eyes showing healed lesions