• Written By: Ralph D. Levinson, MD

    This retrospective analysis of Thai patients with cytomegalovirus (CMV) retinitis found that many already had advanced disease with retinal detachment at the time of diagnosis.

    The authors write that this study is novel in that it reports risk factors for CMV retinitis–related retinal detachment in a developing country where almost all patients are treated with highly active antiretroviral therapy (HAART) and intravitreal ganciclovir injections.

    Patients at risk for CMV retinitis in Southeast Asia are not routinely screened, and the disease is often at an advanced stage at the time of initial diagnosis. Furthermore, patients are often diagnosed with CMV retinitis several months after starting HAART, raising the possibility that retinal infections are present before institution of antiretroviral therapy but not symptomatic until the onset of inflammatory sequelae from immune recovery.

    In light of this data, the authors reviewed the charts of 64 patients (64 eyes) with CMV retinitis–related retinal detachment and 192 patients with CMV retinitis but no retinal detachment seen at a tertiary ophthalmology clinic in northern Thailand.

    As expected, worse vision, bilateral disease and lesion size were risk factors for retinal detachment, all implying that there may be an improved prognosis with earlier treatment.

    On the other hand, 25% of the retinal detachments were diagnosed nine months after the initial diagnosis of CMV retinitis. Since the only treatment for CMV retinitis available was intravitreal ganciclovir, it was impossible to determine if intravitreal injections played a role. Similarly, it was not clear if retroviral therapy and immune re-constitution may have conferred risk, but even if it does, it is clearly a risk worth taking.

    They conclude that efforts to expand the diagnostic capacity for CMV retinitis may lead to earlier detection and treatment, thereby reducing retinal detachments and blindness in these patients.