Cytomegalovirus retinitis: Difference between revisions

| name = Cytomegalovirus retinitis

| synonyms = CMV = retinitis

| image = Fundus photograph-CMV retinitis EDA07.JPG

| alt=| caption = Fundus photograph of CMV retinitis

| pronounce =

| field =

| symptoms = Blurred vision<ref name= nih/>

| complications =

| onset =

| duration =
| types =

'''Cytomegalovirus retinitis''', also known as '''CMV retinitis''', is an inflammation of the [[retina]] of the [[human eye|eye]] that can lead to [[blindness]].<ref name="nih">{{Cite webencyclopedia|url=https://www.nlm.nih.gov/medlineplus/ency/article/000665.htm|title=Cytomegalovirus retinitis :| encyclopedia = MedlinePlus Medical Encyclopedia |website publisher =www U.nlmS.nih.gov National Library of Medicine |access-date=2016-03-14}}</ref> Caused by [[human cytomegalovirus]], it occurs predominantly in people whose [[immune system]] has been compromised, 15-40% of those infected with AIDS.<ref>{{Cite book|url=https://books.google.com/books?id=X7XTAwAAQBAJ|title=Principles and Practice of Vitreoretinal Surgery|last vauthors = Narendran V|first=Narendran|last2=, Kothari|first2=Abhishek A |date=2014-05-30|publisher=JP Medical Ltd|page=571|isbn=9789351520979978-9-351-52097-9 |language=en}}</ref> There are different types of [[retinitis]], such as retinitis pigmentosa (causes [[tunnel vision]]).{{medical citation needed|date=March 2016}}

==Signs/ and symptoms==

The symptoms of cytomegalovirus retinitis have it usually starting in one eye (and also have the possibility of retinal detachment), presenting as:<ref name=nih/>

* [[Blurred vision]]

* [[Blind spot (vision)|Blind spotspots]]s

* Specks in your vision

[[Human cytomegalovirus]] (HCMV or CMV) is a [[DNA virus]] in the family ''[[Herpesviridae]]'' known for producing large cells with nuclear and cytoplasmic inclusions,<ref>{{Cite book | vauthors = Ray K, Bala M | chapter = Human Cytomegalovirus Infection |url=https://books.google.com/books?id=kQ9tAwAAQBAJ|title=Sexually Transmitted Infections |last edition =Kumar 2nd |first=Bhushan|last2 veditors = Kumar B, Gupta|first2=Somesh S |date= February 2014-02-10 |publisher=Elsevier Health Sciences|page=399|isbn=9788131229781978-8-131-22978-1 |language=en}}</ref> CMV infects around 40% of the population worldwide.<ref>{{cite book |vauthors=Offermanns S, Rosenthal W | title = Encyclopedia of Molecular Pharmacology |url=https://archive.org/details/encyclopediamole12rose |url-access=limited | edition = 2nd | pages = 437–438[https://archive.org/details/encyclopediamole12rose/page/n459 437]–438 | publisher = Springer | year = 2008 | isbn = 978-3-540-38916-3 }}</ref>

Rhegmatogenous retinal detachments can occur following the development of holes in areas of healed retinitis (retina may be [[atrophic]]).<ref>{{Cite web | vauthors = Wu L, Pakalnis VA | date = 8 October 2019 | veditors = Law SK, Charles S, Dahl AA |url=http://emedicine.medscape.com/article/1224737-clinical#b5|title=Rhegmatogenous Retinal Detachment Clinical Presentation: History, Physical, Causes|website work =emedicine.medscape.com Medscape |access-date=2016-03-16}}</ref><ref>{{Citecite journal |last vauthors = Cheeran|first=Maxim C.-J.|last2=MC, Lokensgard|first2=James R.|last3=JR, Schleiss MR |first3=Mark R.|date=2009-01-01|title = Neuropathogenesis of Congenitalcongenital Cytomegaloviruscytomegalovirus Infectioninfection: Diseasedisease Mechanismsmechanisms and Prospectsprospects for Interventionintervention | journal = Clinical Microbiology Reviews | issn = 0893-8512 | volume = 22 | issue = 1 | pages = 99–126, Table of Contents | date = January 2009 | pmid = 19136436 | pmc = 2620634 | doi = 10.1128/CMR.00023-08|issn=0893-8512|pmc=2620634|pmid=19136436 }}</ref> [[Proliferative vitreoretinopathy]] has been observed in cases of retinal detachment.<ref>{{Citecite journal |last vauthors = Sadaka|first=Ama|last2= A, Giuliari|first2=Gian Paolo|date=2012-01-01GP | title = Proliferative vitreoretinopathy: current and emerging treatments | journal = Clinical Ophthalmology | issn = 1177-5467 | volume = 6 | pages = 1325–1333 | date = January 2012 | pmid = 22942638 | pmc = 3429288 | doi = 10.2147/OPTH.S27896 |issn=1177 doi-5467|pmcaccess =3429288|pmid=22942638 free }}</ref>

The diagnosis of CMV retinitis can be done via the following:<ref name=emed/><ref>{{Cite book|url=https://books.google.com/books?id=vZxqM6cuQI4C|title=Diagnosis & Treatment of Uveitis|last vauthors = Foster|first=C. Stephen|last2=CS, Vitale|first2=Albert T.AT |date=2013-03-30|publisher=JP Medical Ltd|page=449|isbn=9789350255728978-9-350-25572-8 |language=en}}</ref>

* CMV [[DNA]] capture ( polymerase chain reaction (PCR) test)

* DNA [[Polymerase chain reaction|PCR]] ( ocular fluids)

* Complete blood count

In terms of the treatment of cytomegalovirus retinitis, oral [[valganciclovir]], intravenous [[ganciclovir]], IV [[foscarnet]], and IV [[cidofovir]] are all efficient in the treatment of this condition. Also intravitreal injections, an injection of medicine into the vitreous near the retina,<ref>{{Cite web|url=https://www.nlm.nih.gov/medlineplus/ency/article/007629.htm|title=Intravitreal injection: MedlinePlus Medical Encyclopedia|website=www.nlm.nih.gov|access-date=2016-03-16}}</ref> of [[foscarnet]] in concomitance with oral valganciclovir can be used for treatment as well.<ref>{{Cite web|url=https://aidsinfo.nih.gov/guidelines/html/4/adult-and-adolescent-oi-prevention-and-treatment-guidelines/337/cmv|title=Cytomegalovirus Disease {{!}} Adult and Adolescent OI Prevention and Treatment Guidelines {{!}}| work = AIDSinfo |website publisher =AIDSinfo U.S. National Institutes of Health |access-date=2016-03-16|archive-date=2016-03-23|archive-url=https://web.archive.org/web/20160323165559/https://aidsinfo.nih.gov/guidelines/html/4/adult-and-adolescent-oi-prevention-and-treatment-guidelines/337/cmv|url-status=dead}}</ref><ref name="pat">{{Cite web | vauthors = Tidy C | date = 12 March 2014 | veditors = Huinsn H |url=http://patient.info/doctor/inflammatory-retinal-diseases|title=Inflammatory Retinal Diseases. |language=en-GB|access-date=2016-03-16 | work = Patient | publisher = Egton Medical informationInformation Systems Limited | location = Leeds, UK {{!}}</ref><ref>{{Cite encyclopedia Patient|websiteurl=Patient https://www.nlm.nih.gov/medlineplus/ency/article/007629.htm |languagetitle=en-GBIntravitreal injection| encyclopedia = MedlinePlus Medical Encyclopedia| publisher = U.S. National Library of Medicine |access-date=2016-03-16}}</ref>

Often individuals with CMV retinitis will need surgery for either [[retinal detachment]] or intravitreal instillation of ganciclovir. Retinal detachment occurs in up to 29% of affected eyes, repair being most effective with endolaser and [[silicone oil]] endotamponade.
Intravitreal ganciclovir implant has the benefit of less systemic toxicity. An adverse effect of this is retinal detachment (and vitreous hemorrhage), also there is no systemic beneficial effect for cytomegalovirus organ disease.<ref name=emed/>

== See also ==

* [[List of eyesystemic diseases andwith ocular disordersmanifestations]]

== References ==

== Further reading ==

* {{Citecite journal |last vauthors = Campbell|first=Robert J|last2=RJ, Chow|first2=Benjamin|last3= B, Victor|first3=Gary|last4= G, Kravcik|first4=Steven|last5= S, Hodge WG |first5=William G|date=2001-01-01|title = Treatment of CMV retinitis with intravitral ganciclovir in the HAART era | journal = The Canadian Journal of Infectious Diseases | issn = 1180-2332 | volume = 12 | issue = 5 | pages = 300–304 |issn date =1180-2332|pmc=2094829 September 2001 | pmid = 18159353 | pmc = 2094829 | doi = 10.1155/2001/851845 | doi-access = free }}

| DiseasesDB =

| ICD10 = {{ICD10|B|25|8|b|25}}, {{ICD10|H|30|9|h|30}}

| ICD9 = {{ICD9|078.5}}

| ICDO =

| OMIM =

| MedlinePlus = 000665

| eMedicineSubj = oph

| eMedicineTopic = 701