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Purpose: To study the clinical features, treatment and outcome of ocular cytomegalovirus (CMV) infection.
Methods: Retrospective case series. Medical records of patients who had ocular CMV infection treated at Thammasat university hospital, Thailand from January 2015 to May 2017 were included. Clinical features, treatments and outcomes were analyzed.
Results: Forty-one patients were diagnosed with ocular CMV diseases including infection in immunocompetent patients (n=25, 61%) and infection in immunocompromised cases (n=16, 39%). Among the immunocompetent group, anterior uveitis was the most common manifestation (n=22, 88%). Posner Schlossman syndrome (n=14, 56%) was majority of CMV anterior uveitis. Patients with CMV anterior uveitis had iris atrophy in 90.5% of cases, increased intraocular pressure in 88% of cases, decreased endothelial cell count in 38.1% of cases and coin-shaped lesions in 27.3% of cases. Anti-viral therapy was administered in 88% of cases and 64% of cases needed long-term topical corticosteroids. Most immunocompromised patients were diagnosed with CMV retinitis (93.8%). Almost all patients (n=14, 87.5%) were HIV infection. Immune recovery uveitis was developed in 20%. Five cases (31.3%) of CMV retinitis received intravenous ganciclovir with adjunctive intravitreal injections of ganciclovir while 68.8% of cases were treated with only intravitreal injections of ganciclovir. Most patients well responded to treatment with the mortality rate of 6.3%.
Conclusions: Cytomegalovirus can infect both immunocompetent and immunocompromised host with variety of clinical features. Anterior uveitis was common in immunocompetent cases while retinitis was common in immunocompromised patients.
Conflicts of interest: There is no conflicting relationship exists for any author.
Keywords: Cytomegalovirus, anterior uveitis, retinitis, endotheliitis
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