Clinical Characteristics Associated with the Development of Cystoid Macular Edema in Patients with Cytomegalovirus Retinitis

Analysis of prognostic factors in acute retinal necrosis using ultrawide-field fundus imaging

PURPOSE

This study aimed to identify prognostic factors for retinal detachment (RD) and final best corrected visual acuity (BCVA) in acute retinal necrosis (ARN) patients using ultrawide-field (UWF) fundus imaging.

METHODS

This retrospective study included 29 eyes of 25 patients diagnosed with ARN. Clinical data, including symptom duration before presentation, initial and final BCVA, anterior chamber (AC) cell grade, and vitreous opacity grade, were collected. Based on the UWF fundus imaging, the presence of arterial obliteration and the extent of retinal necrosis were analyzed to identify risk factors for RD by categorizing patients into the RD and no RD groups.

RESULTS

The mean final BCVA was 0.72 ± 0.77 logarithm of the minimum angle of resolution (logMAR), and RD occurred in 20 eyes (70.0%). Final BCVA showed a significant difference between the RD and no RD groups. AC cell grade was significantly associated with both RD development and final BCVA (p = 0.035, p = 0.015, respectively). Arterial obliteration, fan-shaped necrotic lesions, and greater clock hours of retinitis were significantly related to RD development (p = 0.016, p = 0.001, p = 0.018, respectively). The retinitis zone was significantly correlated with final BCVA (p = 0.007). Additionally, BCVA before and at RD diagnosis showed a significant association with final BCVA.

CONCLUSIONS

UWF imaging is useful for the prognosis prediction in ARN patients. Identifying characteristic UWF findings, such as arterial obliteration and extent of necrosis, can aid in predicting RD risk and visual outcomes, improving clinical management of ARN.

KEY MESSAGES

WHAT IS KNOWN : Acute retinal necrosis (ARN) is a rapidly progressing inflammatory condition characterized by necrotizing retinitis and vasculitis. Retinal detachment (RD) is a common late complication of ARN, often leading to poor visual prognosis.

WHAT IS NEW

Ultrawide-field (UWF) imaging is useful for the prognosis prediction of ARN. UWF image analysis identified arterial obliteration, fan-shaped necrotic lesions, and an increased number of clock hours affected by retinitis as significant risk factors for the development of RD in ARN. Additionally, the zone of necrotic retinitis was strongly associated with the final best corrected visual acuity (BCVA) in ARN patients.

Clinical Characteristics and Prognostic Factors Affecting Clinical Outcomes in Cytomegalovirus Retinitis Following Allogeneic Hematopoietic Stem Cell Transplantation

Background/Objectives: This study aimed to evaluate the clinical characteristics and identify the prognostic factors affecting visual outcomes, retinal detachment, and recurrence in cytomegalovirus retinitis (CMVR) patients following allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods: A retrospective analysis of 54 CMVR patients (84 eyes) who underwent allo-HSCT between 2015 and 2024 was conducted. Ophthalmologic and systemic evaluations were performed. The visual outcomes were classified as improvement, stabilization, and deterioration. Logistic regression and LASSO regression models were used to identify the prognostic factors. Results: Improved or stabilized visual outcomes were found in 22 eyes, while 62 eyes suffered from deterioration. Larger lesion areas were independently associated with poorer visual outcomes (OR 0.989, p = 0.002). Eight (9.5%) eyes had rhegmatogenous retinal detachment and thirteen (15.5%) eyes suffered from recurrence. Retinal detachment was significantly predicted by higher baseline aqueous CMV DNA load (OR 5.087, p = 0.026). Macula involvement (OR 5.322, p = 0.032) and more intravitreal injections (IVs) (OR 1.263, p = 0.008) were independent risk factors for recurrence. No systemic factors were found to be associated with the clinical outcome of eyes with CMVR. Conclusions: Ocular characteristics, rather than systemic factors, were more useful to predict the clinical outcome of eyes with CMVR. Routine ophthalmic screening and early intervention are essential to improving outcomes in this vulnerable population.

Uveitic Macular Edema: Clinical Outcomes in Real-World Practice

PURPOSE

To examine the real-world management and outcomes of uveitic cystoid macular oedema (CME).

DESIGN

Retrospective study.

METHODS

Patients with uveitic CME were identified from the Inflammatory Eye Disease database. 248 eyes of 218 patients with uveitic CME were identified. Main Outcome Measures: Time to resolution, time to recurrence and vision loss.

RESULTS

Median age at time of CME was 51.7 years [IQR 37.3-63.9]. Overall likelihood of resolution was 209/248 eyes (85.3%). Resolution occurred in 34.1% with topical therapy, 69.2% treated with oral prednisone (72.9% if prednisone dose ≥ 60 mg/day), 73.5% treated with orbital floor steroid, and 86.7% treated with intravitreal steroid. On multivariate analysis, ERM was associated with decreased resolution of CME (HR 0.735 p = 0.045). Additionally, infectious aetiology approached significance (HR 0.635 p = 0.059) for CME resolution. Recurrence occurred in 85 eyes (36.5%). Predictors of increased likelihood of recurrence were current smoking status (HR 1.818 p = 0.042) and subretinal fluid at diagnosis (HR 1.577 p = 0.043). Eyes with infectious aetiology had lower chance of CME resolution, but those that did resolve had lower probability of recurrence (HR 0.891 p = 0.019). Moderate vision loss (20/50-20/200) occurred in 24 eyes (9/7%) and severe vision loss (≤20/200) in 17 eyes (6.9%).

CONCLUSIONS

Management of CME is challenging given the heterogeneous aetiologies, severity of the macular edema as well as response to the therapy. A high rate of resolution was observed, given sufficient time, but recurrence occurs in one-third. Current smoking status plays an important role in the risk of recurrence of CME and patients should be encouraged to stop smoking.

Cytomegalovirus Retinitis: Clinical Manifestations, Diagnosis and Treatment

Cytomegalovirus (CMV) retinitis is the most common eye disease associated with CMV infection in immunocompromised individuals. The CMVR may initially be asymptomatic; however, relatively mild vitreous inflammation at the onset may be an important differential point from other diseases in HIV patients. Fundus photography, CD4 T-cell count, and telemedicine could be used to screen and monitor the high-risk population, particularly in resource-limited regions. Retinitis generally starts in the peripheral retina and advances toward the posterior pole, which could develop to the characteristic "pizza pie" appearance marked by central retinal necrosis and intraretinal hemorrhage. CMVR causes vision loss if left untreated, and early antiviral therapy significantly reduces the risk of vision loss. Alongside traditional antiviral treatments, immunotherapies including CMV-specific adoptive T-cell therapy and CMV immunoglobulin (CMVIG) are emerging as promising treatment options due to their favorable tolerability and reduced mortality. This review comprehensively examines CMV retinitis, encompassing the clinical features, differential diagnosis, laboratory tests, and updated treatment strategies to inform clinical management.

CMV retinitis and subsequent acute cystoid macular oedema after treatment with vitreous ganciclovir injection: a case report

Background

To report a very rare acute cystoid macular oedema following ganciclovir injection in patients receiving allogeneic haematopoietic stem cell transplantation.

Case presentation

A 44-year-old male patient experienced vision loss in his left eye eight months after allogeneic stem cell transplantation. Ophthalmologic examination showed posterior retinopathy with retinal haemorrhage, a yellow necrotic border, and a vascular white sheath involved in the superior temporal retina but not the posterior pole. Cytomegalovirus DNA results in both plasma and ocular fluid were positive. All tests combined with the patient’s medical history suggested that his ocular disease was cytomegalovirus retinitis. Consequently, he received a weekly ganciclovir vitreous injection. The disease was visibly controlled, and the fundus condition improved after the first three treatments. However, the patient had severe vision loss in his left eye and acute cystic oedema in the macula, while the original lesion was stable two hours after the fourth treatment. The macular oedema subsided significantly on the first day. Over the next week, daily OCT findings indicated that the patient's macular oedema gradually subsided and resolved completely by the second week, and his left eye vision partially improved.

Conclusion

Macular oedema may occur in patients with cytomegalovirus retinitis, but it rarely occurs during treatment. In this case, the patient's macular oedema appeared and resolved quickly. Macular oedema in patients with cytomegalovirus retinitis receiving vitreous cavity injections of ganciclovir needs to be further studied and discussed.