ObjectiveTo observe the image characteristics of OCT in patients of acquired immunodeficiency syndrome (AIDS) with cytomegalovirus retinitis (CMVR).MethodsThirty-nine eyes of 26 patients of AIDS with CMVR diagnosed in Department of ophthalmology of Beijing Ditan Hospital Capital Medical University from January 2015 to December 2017 were included in this study. All the patients were males, with the mean age of 33.12±9.87 years. All the patients underwent the OCT examination by Spectralis HRA+OCT. The locations of scanning were macular, optical papilla and posterior pole of retina with retinitis. Typical images were saved and analyzed.ResultsThe OCT pathological changes of CMVR included increase of retinal thickness and reflex of retina, indiscernible retinal layers, irregularity or absent external limiting membrane and/or ellipsoid zone, hyperreflective spots, vitreous cells. Among 39 eyes, there were 6 eyes with strong point-like reflection in the outer layer of retina around the lesion, 31 eyes (79.49%) with strong point-like reflection in the full layer of retina, 25 eyes (64.10%) with lesion involved macular area, 34 eyes (87.17%) with vitreous cells.ConclusionsOCT images of the eyes with AIDS with CMVR were characterized by lesions involving the whole retina. Absent ellipsoid zone or structural changes can be seen in the affected areas and peripheral areas of the lesion.
Cytomegalovirus (CMV) retinitis (CMVR) is a common opportunistic infection of the eye after allogeneic hematopoietic stem cell transplantation in patients with hematological diseases. It often occurs within 3 months after the operation, with CMV activation and high blood CMV peaks. It often occurs on patients with long-term CMV viremia, human leukocyte antigen incompatible transplantation, unrelated donor transplantation, haploid transplantation, childhood hematopoietic stem cell transplantation, delayed lymphocyte engraftment, acute and chronic graft-versus-host disease after surgery. The visual prognosis of patients is related to the area of CMVR lesions on the retina, the number of quadrants involved, whether the macula is involved, and the CMV load of the vitreous body is involved, and it is not related to whether the Epstein-Barr virus infection is combined with blood and vitreous humor. The incidence of CMVR is increasing year by year. It is helpful that paying attention to systemic risk factors and epidemiology can provide more effective guidance for ophthalmologists during diagnosis and treatment, help patients improve the prognosis of vision, and reduce or even avoid the occurrence of blindness caused by CMVR.
ObjectiveTo observe the clinical features of cytomegalovirus (CMV) retinitis (CMVR)-related uveitis after hematopoietic stem cell transplantation (HSCT).MethodsA retrospective clinical study. From October 2015 to May 2020, 14 cases of 21 eyes of CMVR patients with CMVR after HSCT confirmed by the ophthalmological examination of The First Affiliated Hospital of Soochow University were included in the study. Among them, there were 5 males with 8 eyes and 9 females with 13 eyes. The average age was 35.12±12.24 years old. All the affected eyes were examined by slit lamp microscope combined with front lens and fundus color photography. At the same time, fluorescein fundus angiography (FFA) was performed to examine 10 eyes of 5 cases; 3 cases of 3 eyes were examined for inflammatory cytokines in aqueous humor. All eyes received intravitreal injection of ganciclovir; patients with a history of systemic CMV infection received intravenous infusion of ganciclovir/foscarnet. The retinal lesions in the eye were completely resolved or the aqueous CMV-DNA was negative as a cure for CMVR. The uveitis symptoms, signs, FFA manifestations and the test results of inflammatory factors in aqueous humor before and after the CMVR cure was observed. The follow-up time after CMVR was cured was 3-42 months, and the average follow-up time was 14.28±13.12 months.ResultsAll eyes with CMVR were diagnosed with retrocorneal dust and/or stellate keratic precipitates (KP), anterior chamber flare and cells, and varying degrees of vitreous flocculent opacity; the retina was typical of a mixture of hemorrhage and yellow-white necrosis like "scrambled eggs with tomatoes". After CMVR was cured, there were 16 eyes (71.4%, 10/14) in 10 cases with KP, anterior chamber flare, cell and vitreous opacity. FFA examination revealed that the majority of retinal leakage during the active period of CMVR was necrotic foci and surrounding tissues; after CMVR was cured, the majority of retinal leakage was the retina and blood vessels in the non-necrotic area. The test results of inflammatory factors in aqueous humor showed that interleukin (IL)-6, IL-8, and vascular endothelial cell adhesion molecules were significantly increased in the active phase of CMVR; after 3 months of CMVR cured, inflammatory factors did not increase significantly.ConclusionCMVR-associated uveitis after HSCT show as chronic panuveitis, with no obvious eye congestion, KP, anterior chamber flare, cell and vitreous opacity, and retinal vessel leakage which could exist for a long time (＞3 months).
Objective To evaluate the clinical features, diagnosis, and outcome of the treatment of cytomegalovirus (CMV) retinitis, and the relationship between CMV retinitis and acquired immunodeficiency syndrome (AIDS). Methods A total of 95 eyes of 56 patients with cytomegalovirus retinitis and AIDS were studied. The fundus feature, visual acuity and CD4+ T-lymphocyte counts were analyzed and the follow-up periods ranged from 2 weeks to 18 months. Results Before the definitive diagnosis of CMV retinitis, the courses of AIDS were 4 to 26 months in all patients. In the initial examination, the granular form of CMV retinal lesion was noted in 55 eyes (57%) in which retinal lesion of 46 eyes was peripheral. The fulminant form of CMV retinitis of 25 eyes (26%) was found in the posterior pole and consisted of densely opaque retinal lesions with blotchy hemorrhage and vasculitis. The overlap between these two presentations was noted in 15 eyes. Papillitis was observed in 7 eyes of CMV retinitis in this series of patients. The visual acuity ranged from finger counting to 0.5. The patients with extensive CMV retinitis or CMV retinitis in the posterior pole got poorer vision. The CD4+ T-lymphocyte counts of 30 patients was 0-30 (mean, 15±9/μl), and the survival time ranged from 2 weeks to 18 months (mean, 6.4±3.3 months). The vision was improved and CD4+ T-lymphocyte counts was significantly higher in the group treated with ganciclovir, and progression of CMV retinitis occured and the vision decreased in the non-treated group. Conclusion CMV retinitis is the most common intraocular complication in patients with AIDS. Diagnosis of CMV retinitis is based on the characteristic of necrotizing retinitis which was typically associated with retinal hemorrhage and vasculitis. Ganciclovir is effective for the treatment of CMV retinitis. (Chin J Ocul Fundus Dis, 2002, 18: 89-91)
【Abstract】Objective To study the characteristics, diagnosis, treatment and prophylaxis of cytomegalovirus (CMV) infection after liver transplantation. Methods The literatures of recent 10 years were collected and reviewed. ResultsThe infection rate of CMV after liver transplantation was high, and it was frequently complicated with other types of infectious diseases. There was no specificity in the clinical features of CMV infection, and no effective measures were taken for early diagnosis, prevention and therapy.Conclusion CMV is the primary opportunistic pathogen after liver transplantation. Monitoring the status of CMV infection in recipients preoperatively and postoperatively, early prophylaxis and treatment are very important and useful to prevent and treat this disease.
Objective To investigate the clinical features of pnuemonia in renal transplant recipients in order to improve the clinical diagnostic and treatment efficacy.Methods The clinical data of 29 recipients with pneumonia following renal transplantation in Peking University People’s Hospital from January 1,1999 to July 31,2006 were collected and analyzed retrospectively.Results Of the 29 cases with pneumonia，one case（3.4%，1/29）were diagnosed as nosocomial acquired pneumonia and twenty eight cases（96.6%，28/29）as community acquired pneumonia.Of the total,cytomegalovirus （CMV） pneumonia were validated in 19 cases, bacteria pneumonia in 10 cases, fungus pneumonia in 3 cases,and Pneumocystis Carini infection in one case while none pathogen were confirmed in 5 cases with pneumonia.37.5%（9/24）cases with pneumonia which pathogen were ascertained were resulted from multiple pathogen infection.Opportunistic organism is the main pathogen of pneumonia in renal transplant recipients and the disease commonly manifested as interstitial pneumonia. 27 cases（93.1%）developed to severe pneumonia in which 15 cases were deteriorated to acute respiratory distress syndrome.Excluding 5 cases who withdrew from the hospital,4 cases （16.7%，4/24）died and 20（83.3%，20/24） cases were cured.During the second to the sixth month especially the second to the thrid month after renal transplantation the recipients were at higher-risk of pneumonia.Conclusions The majority of pneumonia in kidney recipients were severe community acquired pneumonia caused by multiple pathogens.CMV pneumonia and bacteria pneumonia are the most common types and major causes of mortality.Mortality of fungus pneumonia and CMV pneumonia are highest.Proper diagnostic procedures and therapeutic strategies are critical to improve survival rate.
ObjectiveTo evaluate the efficacy and safety of reduced-dose intravitreal ganciclovir for the treatment of acquired immunodeficiency syndrome (AIDS) patients with cytomegalovirus retinitis (CMVR).MethodsA prospective observational cohort study observed 15 AIDS patients (28 eyes) who suffered from CMVR onset between January 2016 and December 2018 at Nanning Aier Eye Hospital. Among this 28 eyes, BCVA of 6 eyes (21.4%) were between moving hand to counting finger, 15 eyes (53.6%) were between 0.02 to 0.1 and 7 eyes were better than 0.1 (25.0%). All eyes received intravitreal injection 0.1 ml of ganciclovir at 4 mg/ml (contain ganciclovir 0.4 mg). The induction regimen was twice weekly for 2 weeks and a maintenance period of the same dose weekly. The mean number of injections was 7.1±1.7 times. For hospitalized patients who had no contraindicated received a 14-day twice daily intravenous ganciclovir (IVG) 5.0 mg/kg·d until complete resolution of CMVR. All patients were divided into intravitreal ganciclovir (IVTG) group and IVTG+IVG group according to different treatment plans, which were 5 cases with 8 eyes and 10 cases with 20 eyes, respectively. The follow-up was more than 6 months. BCVA, complete resolution or stable of the lesion and complications were observed.ResultsSix months later, 20 eyes (71.4%) had a obvious reduced or disappeared of the anterior chamber and vitreous inflammation, and the retinal lesions became stable or complete resolution. 24 eyes showed improvements of BCVA and 4 eyes showed stable. 2 eyes (7.1%) presented with BCVA ≤ counting finger, 7 eyes (25.0%) were 0.02 - 0.1 and 19 eyes were ≥ 0.1 (67.9%). Compared with before treatment, the ratio of BCVA that less than or equal to counting finger and between 0.02 to 0.1 decreased (21.4% vs 7.1% and 53.6% vs 25.0%, respectively), but the ratio of BCVA better than 0.1 increased (25.0% vs 67.9%). When IVTG+IVG group was compared with IVTG group, the average time-to-resolution of CMVR were 83.2±25.2 and 85.3±24.4 days respectively. There was no significant difference in resolution times (Z=0.17, P=0.87). The ratio of retinal lesions became stable or complete resolution were 75.0% (15 eyes) and 62.5% (5 eyes), there was no evident difference in time-to-resolution between the two groups (F=0.42, P=0.51). No recurrence was seen during the follow-up period. In cases of unilateral CMVR, there were no patients with a second eye involvement during the follow-up period. No endophthalmitis, vitreous hemorrhage, retinal detachment were found in our study.ConclusionReduced-dose intravitreal ganciclovir is a safe and effective treatment option for CMVR.
ObjectiveTo observe aqueous cytomegalovirus (CMV) DNA load in patients with cytomegalovirus retinitis (CMVR) after allogeneic hematopoietic stem cell transplantation (Allo-HSCT), and to explore influencing factors for transient elevation of CMV-DNA load during the treatment. MethodsA retrospective study. From January 2016 to July 2020, 28 eyes of 19 patients with CMVR after Allo-HSCT diagnosed in the Department of Ophthalmology of Peking University People's Hospital were included in the study. Among them, there were 8 males with 12 eyes, 11 females with 16 eyes; the mean age was 28 years; 10 patients were unilateral and 9 patients were bilateral. During the course of treatment and follow-up, the blood CMV-DNA remained negative. All patients were treated with intravitreal injection of 60 mg/ml ganciclovir 0.05 ml (containing ganciclovir 3 mg), twice a week for two weeks in induction phase and weekly injection in maintenance phase. Aqueous humor sample was collected during injection of ganciclovir (IVG) and CMV-DNA load was determined by real-time quantitative polymerase chain reaction. Intravitreal treatment was terminated if aqueous CMV-DNA load turned negative after the fourth or later intravitreal injection. The patients were followed up every 2 weeks for at least 6 months. Serum CMV-DNA was negative in all patients during treatment and follow-up. All the eyes were divided into continuous decline group and non-continuous decline group depending on whether there was transient elevation of aqueous CMV-DNA load, and data between two groups were compared. Pearson linear regression analysis was used to analyze the correlation between aqueous CMV-DNA load and injection times or treatment duration. ResultsAt the end of treatment, the median number of IVG in the affected eye was 7 (4, 9). The results of correlation analysis showed that the aqueous humor CMV-DNA load of the affected eye was related to the number of treatments [R2=0.385, P＜0.000 1, B=－0.237 log10 copies/(ml · time)], and the duration of treatment [R2=0.394, P <0.000 1, B=－0.301 log10 copies/(ml · week)] were negatively correlated. Among the 28 eyes, 13 eyes (46.4%, 13/28) in the continuous decline group and 15 eyes (53.6%, 15/28) in the non-sustained decline group. Baseline visual acuity (t=－1.223), intraocular pressure (t=1.538), aqueous humor CMV-DNA load (t=－0.109), retinitis lesion area (Z=－0.308) in the continuous decline group and the non-continuous decline group), the number of quadrants involved (Z=－0.024) and whether the macula was involved (Z=－1.826), combined with anterior segment inflammation (Z =－0.499), combined with high intraocular pressure (Z=－1.342), terminal visual acuity (t =－0.845), intraocular pressure (t=－0.068), total IVG times (Z=0.907), age (Z=－0.832), gender composition (Z=－1.074), etc. The difference was not statistically significant (P＞0.05). ConclusionThe CMV-DNA load in aqueous humor decreases by about 50% every week during the treatment of CMVR eyes after Allo-HSCT; the transient increase in the CMV-DNA load in the aqueous humor during treatment does not affect the treatment process and clinical prognosis.
ObjectiveTo observe the ultra-wide-angle fundus imaging characteristics of acquired immunodeficiency syndrome (AIDS) combined with cytomegalovirus retinitis (CMVR).MethodsThis study was a retrospective study. From July 2017 to November 2019, 124 eyes of 86 patients diagnosed with AIDS and CMVR at the Department of Ophthalmology, Beijing You'an Hospital, Capital Medical University, were included in the study. Among them, 80 patients were males (93.0%) and 6 patients were females (7.0%) with 17-58 years old. The average age was (36.86±8.82) years old. There were 48 cases (55.8%) in one eye and 38 cases (44.2%) in both eyes. All the affected eyes underwent indirect ophthalmoscope fundus examination and Aalborg ultra-wide-angle fundus photography examination. According to the characteristics of CMVR in ultra-wide-angle fundus images, it can be divided into classic type, granular type, frost-like dendritic vasculitis and optic neuroretinitis. We observed and analyzed the type of fundus of the affected eye. According to the position of the vortex vein in the fundus image and record of the lesion as the posterior pole or peripheral part, the scope of the lesion was divided into ≤1 quadrant, ＞1 quadrant and ≤2 quadrants (1-2 quadrants), ＞2 quadrants and ≤3 quadrants (2-3 quadrants), ＞3 and ≤4 quadrants (3-4 quadrants). The upper and lower vascular arches or disc edges of the macula were used as boundaries to record whether the macular area or optic disc was involved. At the same time, we recorded whether the vitreous body had obvious turbidity. The comparison of CD4+ T lymphocyte count between patients of different types was performed by one-way analysis of variance, and the comparison of the positive rate of blood CMV-DNA was performed by the χ2 test; pairwise comparisons between groups were performed by the least significant difference method.ResultsAmong the 124 eyes, CMVR was classified into 35 eyes (28.2%) with classic type, 68 eyes with granular type (54.8%), 3 eyes with frost-like dendritic vasculitis (2.4%), and 18 eyes with optic neuroretinitis (14.5%). The lesion involved 83 eyes (66.9%) at both the posterior pole and the periphery, 22 eyes (17.7%) confined to the posterior pole, and 19 eyes (15.3%) confined to the periphery; the extent of the lesion was ≤1 quadrant in 76 eyes (61.3%), 23 eyes (18.5%) in 1-2 quadrants, 7 eyes (5.6%) in 2-3 quadrants, and 18 eyes (14.5%) in 3-4 quadrants. 54 eyes (43.5%) showed lesions involving the macular area; 52 eyes (41.9%) had lesions involving the optic disc; 33 eyes (26.6%) showed obvious vitreous inflammatory opacities. Among 86 patients, the average number of CD4+ T lymphocytes in 82 patients was 1 to 168 cells/μl, with an average of 33.60±40.02 cells/μl; the remaining 4 patients (4.7%) were unknown. There was no statistically significant difference in the positive rate of CD4+ T lymphocyte count and blood CMV-DNA load between patients in different subtypes groups (F=0.863, 0.926; P=0.462, 0.431).ConclusionThe ultra-wide-angle fundus images of AIDS combined with CMVR have certain characteristics, which can manifest as classic, granular, frost-like dendritic vasculitis and optic neuroretinitis.
Objective To evaluate the effectiveness and safety of foscarnet and ganciclovir for cytomegalovirus retinitis associated with acquired immune deficiency syndrome (AIDS). Methods We searched MEDLINE (1966 to 2005.12), EMBASE (1974 to Dec.2005), The Cochrane Library (Issue 4,2005), CBM (1978 to Dec.2005), CMCC (1994 to Dec. 2005), CNKI (1994 to Dec. 2005) and VIP (1989 to Dec. 2005). We identified randomized controlled trials of foscarnet versus ganciclovir. Two independent reviewers collected and evaluated details of study populations, interventions, and outcomes using a data extraction form. We conducted meta-analysis of the homoeonomous data. Result Three studies involving 451 patients were included. Meta-analysis showed foscarnet was better than ganciclovir with the following outcomes: mortality (RR=0.84, 95%CI 0.70 to 1.00, P=0.05); male genital ulcers (RR=1.29, 95%CI 0.60 to 2.82, P=0.002). There were no significant differences in ocular symptoms, relapses and other side effects. Conclusion Foscarnet in the treatment of cytomegalovirus retinitis in AIDS patients may be more benefical than ganciclovir with regard to mortality and male genital ulcers, but the supporting evidence is not very b because there are only three trials.