Classification Criteria for Cytomegalovirus Retinitis

Abstract

Purpose: The purpose of this study was to determine classification criteria for cytomegalovirus (CMV) retinitis.

Design: Machine learning of cases with CMV retinitis and 4 other infectious posterior/ panuveitides.

Methods: Cases of infectious posterior/panuveitides were collected in an informatics-designed preliminary database, and a final database was constructed of cases achieving supermajority agreement on diagnosis using formal consensus techniques. Cases were split into a training set and a validation set. Machine learning using multinomial logistic regression was used in the training set to determine a parsimonious set of criteria that minimized the misclassification rate among the infectious posterior/panuveitides. The resulting criteria were evaluated in the validation set.

Results: A total of 803 cases of infectious posterior/panuveitides, including 211 cases of CMV retinitis, were evaluated by machine learning. Key criteria for CMV retinitis included: 1) necrotizing retinitis with indistinct borders due to numerous small satellites; 2) evidence of immune compromise; and either 3) a characteristic clinical appearance, or 4) positive polymerase chain reaction assay results for CMV from an intraocular specimen. Characteristic appearances for CMV retinitis included: 1) wedge-shaped area of retinitis; 2) hemorrhagic retinitis; or 3) granular retinitis. Overall accuracy for infectious posterior/panuveitides was 92.1% in the training set and 93.3% (95% confidence interval: 88.2-96.3) in the validation set. The misclassification rates for CMV retinitis were 6.9% in the training set and 6.3% in the validation set.

Conclusions: The criteria for CMV retinitis had a low misclassification rate and appeared to perform sufficiently well for use in clinical and translational research.

Figure 1.

Fundus photograph of a case of cytomegalovirus retinitis with a “hemorrhagic” appearance involving the posterior pole, characterized by retinal necrosis and edema, intraretinal hemorrhage and “satellite lesions” at the border.

Figure 2.

Fundus photograph of a case of cytomegalovirus retinitis involving the periphery, characterized by a “granular” appearance and without hemorrhage.

Figure 3.

Fundus photograph of a case of cytomegalovirus retinitis with a wedge shaped appearance with the apex “pointing” toward the optic disc.