Cytomegalovirus retinitis, in a diabetic immunocompetent patient, after intravitreal ranibizumab injection

Cytomegalovirus Retinitis in Immunocompetent Patients with Diabetes Mellitus

Purpose: We report five cases of cytomegalovirus (CMV) retinitis in immunocompetent patients with diabetes mellitus (DM).Methods: This was a retrospective observational case series of five immunocompetent patients with CMV retinitis. All patients had DM and variable degrees of DM retinopathy. After discovery of the retinitis, we assessed the patients in terms of ophthalmologic history, systemic conditions, underlying disease, and the medications used for treatment, such as immunosuppressants. This was followed by blood and immunology tests. None of the five patients were immunocompromised. We confirmed the diagnosis of CMV retinitis by polymerase chain reaction (PCR) analysis; samples were collected by anterior chamber paracentesis. All patients were treated with intravitreal antiviral injection until negative results were obtained for the anterior chamber PCR.Results: All five immunocompetent patients who had developed CMV retinitis, had a history of diabetes of at least 15 years. The average duration of diabetes was 17.4 ± 2.4 (15-20) years, the average HbA1c was 7.3 ± 0.5% (6.8-8.0%), and the average duration and numbers of Intravitreal antiviral injections were 23.8 ± 8.5 months (14-36 months) and 14.8 ± 3.2 times (10-18 times), respectively.Conclusions: We report this case series because CMV retinitis can be complicated even in diabetic patients shown to be immunocompetent.

Long-term prophylaxis in an immunocompetent patient with Cytomegalovirus retinitis: a case report and review of literature

Background

Cytomegalovirus retinitis is an infectious sight-threatening condition that usually occurs in immunosuppressed individuals, but rare cases of Cytomegalovirus retinitis have been reported in immunocompetent patients.

Findings

A 68-year-old woman without any history of systemic diseases referred to the emergency ward of Farabi eye hospital with a two-week history of decreased vision in her left eye. Fundoscopy of the left eye revealed mild venous tortuosity, hemorrhagic retinitis within the macula, and papillitis. The right eye had a history of Cytomegalovirus retinitis 2 years ago that complicated with rhegmatogenous retinal detachment. Immunologic evaluations were normal without any sign of immunosuppressive conditions. She was treated with intravenous ganciclovir for 2 weeks, intravitreal ganciclovir (twice weekly) for 1 week, and also daily oral valganciclovir as maintenance therapy for 6 months resulted in resolving of retinitis patches and improving her best-visual acuity from hand motions to 20/100. Forty-five days after stopping maintenance therapy recurrence occurred. So we started the treatment again to stabilize the patient. She is currently maintained on valganciclovir 900 mg daily without recurrence for 9 months.

Conclusions

Cytomegalovirus retinitis can recur in the same or contralateral eye of immunocompetent patients, especially without prophylactic medication.