Abstract
To identify the visual prognostic factors in patients with cytomegalovirus (CMV) retinitis after hematopoietic stem cell transplantation (HSCT). This retrospective cohort study included 4241 patients who underwent HSCT from April 1, 2010 to March 31, 2019 at Seoul St. Mary's Hospital. Of them, 1063 patients presented CMV viremia, and 67 patients (93 eyes) were diagnosed with CMV retinitis. We enrolled 66 patients (91 eyes). The main outcomes included the initial best-corrected visual acuity (BCVA), BCVA at the diagnosis of retinitis and last visit, involved retinal zone, peak CMV DNA levels in the peripheral blood and aqueous humor, time between HSCT and the diagnosis of retinitis, time between the diagnosis of viremia and retinitis, complications, recurrence, survival, and so on. The mean BCVA (logarithm of the minimum angle of resolution) values before HSCT, at the time of retinitis diagnosis, and at the last visit were 0.041 ± 0.076, 0.262 ± 0.529, and 0.309 ± 0.547, respectively. Multiple regression analysis revealed that the involved zone (P = 0.001), time between HSCT and retinitis diagnosis (P = 0.019), and survival status (P = 0.001) were associated with the final visual acuity. The final visual prognosis was worse in patients with greater invasion of the central retinal zone, those with a longer interval between HSCT and the diagnosis of retinitis, and those who died. Prompt diagnosis of CMV retinitis through periodic fundus examinations of patients with CMV viremia can prevent severe vision loss. Once CMV viremia is confirmed, we recommend fundus examinations to be immediately performed and repeated every 2 weeks for at least 2 months, even if the CMV DNA titer in the peripheral blood becomes negative.
Highlights
The final visual prognosis was worse in patients with greater invasion of the central retinal zone, those with a longer interval between hematopoietic stem cell transplantation (HSCT) and the diagnosis of retinitis, and those who died
Program through the National Research Foundation of Korea (NRF) The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript
Cytomegalovirus (CMV) retinitis is an opportunistic infection that occurs in immunocompromised patients such as those with AIDS, hematopoietic stem cell transplantation (HSCT), solid organ transplantation, malignancy, systemic immunosuppressive therapy, and primary immunodeficiency
Summary
Cytomegalovirus (CMV) retinitis is an opportunistic infection that occurs in immunocompromised patients such as those with AIDS, hematopoietic stem cell transplantation (HSCT), solid organ transplantation, malignancy, systemic immunosuppressive therapy, and primary immunodeficiency. This form of retinitis can lead to severe vision loss if it is not promptly diagnosed and appropriately treated [1,2,3,4,5]. CMV remains in a latent state in the myeloid progenitor cells in the bone marrow or in a low-level replication state, facilitated by multiple immune evasion mechanisms When it is intermittently stimulated, it releases virions and is reactivated, the condition is mostly asymptomatic and self-limiting. CMV reactivation can result in retinitis, hepatitis, esophagitis, gastroenteritis, colitis, pneumonitis, encephalitis, and polyradiculopathy [8,9,10]
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