Cytomegalovirus retinitis
Encyclopedia
Cytomegalovirus retinitis, also known as CMV retinitis, is an inflammation of the eye
's retina
that can lead to blindness
.
(CMV) is a DNA virus
in the family Herpesviridae
known for producing large cells with nuclear and cytoplasmic inclusions. Such inclusions are called an "owl's eye" effect.
While CMV is found in almost everyone, and is usually fought off by the immune system
, for people who are immunocompromised, by diseases, transplants, or chemotherapy
the virus is not adequately destroyed and can cause damage to the eye and the rest of the body. HIV positive persons are most at risk, especially when the CD4
cell count is low. CMV commonly becomes reactivated and can cause systemic infection in immunocompromised persons such as transplant patients or those infected by HIV.
It affects the eye in about 30% of the cases involving immunocompromised patients by causing damage to the retina. Symptoms can include blurred vision, eye pain, photophobia
, redness, and blindness. It may affect just one eye at first, but then may spread to the other.
See retinal photograph of CMV retinitis for the appearance of CMV retinitis.
Because the virus is so threatening to vision, it is usually treated by a vitreo-retinal surgeon, by antivirals such as ganciclovir
or foscarnet
, which can be taken orally, intravenously, injected directly into the eye (intravitreal injection), or through an intravitreal implant.
Aug 1998: Fomivirsen
is the first antisense drug approved by the FDA (brand name Vitravene) as an intraocular injection for the treatment of cytomegalovirus retinitis.
was recently published.
Human eye
The human eye is an organ which reacts to light for several purposes. As a conscious sense organ, the eye allows vision. Rod and cone cells in the retina allow conscious light perception and vision including color differentiation and the perception of depth...
's retina
Retina
The vertebrate retina is a light-sensitive tissue lining the inner surface of the eye. The optics of the eye create an image of the visual world on the retina, which serves much the same function as the film in a camera. Light striking the retina initiates a cascade of chemical and electrical...
that can lead to blindness
Blindness
Blindness is the condition of lacking visual perception due to physiological or neurological factors.Various scales have been developed to describe the extent of vision loss and define blindness...
.
Presentation
CytomegalovirusCytomegalovirus
Cytomegalovirus is a viral genus of the viral group known as Herpesviridae or herpesviruses. It is typically abbreviated as CMV: The species that infects humans is commonly known as human CMV or human herpesvirus-5 , and is the most studied of all cytomegaloviruses...
(CMV) is a DNA virus
DNA virus
A DNA virus is a virus that has DNA as its genetic material and replicates using a DNA-dependent DNA polymerase. The nucleic acid is usually double-stranded DNA but may also be single-stranded DNA . DNA viruses belong to either Group I or Group II of the Baltimore classification system for viruses...
in the family Herpesviridae
Herpesviridae
The Herpesviridae are a large family of DNA viruses that cause diseases in animals, including humans. The members of this family are also known as herpesviruses. The family name is derived from the Greek word herpein , referring to the latent, recurring infections typical of this group of viruses...
known for producing large cells with nuclear and cytoplasmic inclusions. Such inclusions are called an "owl's eye" effect.
While CMV is found in almost everyone, and is usually fought off by the immune system
Immune system
An immune system is a system of biological structures and processes within an organism that protects against disease by identifying and killing pathogens and tumor cells. It detects a wide variety of agents, from viruses to parasitic worms, and needs to distinguish them from the organism's own...
, for people who are immunocompromised, by diseases, transplants, or chemotherapy
Chemotherapy
Chemotherapy is the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen....
the virus is not adequately destroyed and can cause damage to the eye and the rest of the body. HIV positive persons are most at risk, especially when the CD4
CD4
CD4 is a glycoprotein expressed on the surface of T helper cells, monocytes, macrophages, and dendritic cells. It was discovered in the late 1970s and was originally known as leu-3 and T4 before being named CD4 in 1984...
cell count is low. CMV commonly becomes reactivated and can cause systemic infection in immunocompromised persons such as transplant patients or those infected by HIV.
It affects the eye in about 30% of the cases involving immunocompromised patients by causing damage to the retina. Symptoms can include blurred vision, eye pain, photophobia
Photophobia
Photophobia is a symptom of abnormal intolerance to visual perception of light. As a medical symptom photophobia is not a morbid fear or phobia, but an experience of discomfort or pain to the eyes due to light exposure or by presence of actual physical photosensitivity of the eyes, though the term...
, redness, and blindness. It may affect just one eye at first, but then may spread to the other.
See retinal photograph of CMV retinitis for the appearance of CMV retinitis.
Treatment
Active Cytomegalovirus retinitis is treated by an uveitis and ocular immunology specialist.Because the virus is so threatening to vision, it is usually treated by a vitreo-retinal surgeon, by antivirals such as ganciclovir
Ganciclovir
Ganciclovir INN is an antiviral medication used to treat or prevent cytomegalovirus infections.Ganciclovir sodium is marketed under the trade names Cytovene and Cymevene . Ganciclovir for ocular use is marketed under the trade name Vitrasert...
or foscarnet
Foscarnet
Foscarnet is the conjugate base of the chemical compound with the formula HO2CPO3H2.-Uses:This phosphonic acid derivative is an antiviral medication used to treat herpes viruses, including drug resistant cytomegalovirus and herpes simplex viruses types 1 and 2...
, which can be taken orally, intravenously, injected directly into the eye (intravitreal injection), or through an intravitreal implant.
Aug 1998: Fomivirsen
Fomivirsen
Fomivirsen is an antiviral drug. It is used in the treatment of cytomegalovirus retinitis in immunocompromised patients, including those with AIDS...
is the first antisense drug approved by the FDA (brand name Vitravene) as an intraocular injection for the treatment of cytomegalovirus retinitis.
Risk factors
The systemic use of corticosteroids has recently been implicated as elevating the risk of CMV in AIDS patients.Associated conditions
The first report of CMV retinitis in a patient with dermatomyositisDermatomyositis
Dermatomyositis is a connective-tissue disease related to polymyositis and Bramaticosis that is characterized by inflammation of the muscles and the skin.- Causes :...
was recently published.
See also
- List of eye diseases and disorders
- List of systemic diseases with ocular manifestations
- Progressive outer retinal necrosisProgressive outer retinal necrosisProgressive outer retinal necrosis, also known as Varicella zoster virus retinitis , is an aggressive, necrotizing inflammation of the eye's retina caused by herpes varicella zoster virus...
External links
- Cytomegalovirus (CMV) at Healthocates