CHRONIC RETINAL NECROSIS Cytomegalovirus Necrotizing Retinitis Associated With Panretinal Vasculopathy in Non-HIV Patients
CHRONIC RETINAL NECROSIS Cytomegalovirus Necrotizing Retinitis Associated With Panretinal Vasculopathy in Non-HIV Patients
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DOI：
10.1097/iae.0b013e318285f486
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发表时间：
2013-10-01
影响因子：
3.3
通讯作者：
Johnson, Mark W.
中科院分区：
文献类型：
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作者：
Schneider, Eric W.;Elner, Susan G.;Johnson, Mark W.
目的： 表征有限免疫功能障碍患者中一种独特的巨细胞病毒 (CMV) 相关视网膜病变。方法：回顾性观察病例系列。通过对房水或玻璃体液样本进行聚合酶链反应分析或通过对视网膜活检标本进行免疫组织化学分析，确认 CMV 为病原体。 结果：确定了 5 名患有颗粒坏死性视网膜炎、玻璃体炎和严重闭塞性血管病变的非 HIV 患者。患者病史均表明存在有限的免疫功能障碍，包括高龄 (n = 4)、糖尿病 (n = 4) 和非细胞毒性免疫治疗 (n = 3)。所有病例中巨细胞病毒视网膜炎的诊断均被延迟，并且患者要么未接受抗病毒治疗（n = 2），要么因推测的单纯疱疹/水痘带状疱疹相关的急性视网膜坏死而接受了不正确的抗病毒治疗（n = 3）。随后，通过全身应用更昔洛韦/缬更昔洛韦 (n = 5) 和/或玻璃体内膦甲酸 (n = 2)，所有病例的视网膜炎均得到消退。五名患者中有四名因广泛视网膜缺血而发生新生血管。结论：巨细胞病毒相关性视网膜病变的临床表现与免疫状态密切相关。在免疫功能障碍有限的患者中，观察到眼内炎症与全视网膜闭塞性血管病（更具有急性视网膜坏死特征）和周围缓慢进行性颗粒性视网膜炎（更具有典型CMV视网膜炎特征）的混合临床表现。对这种非典型临床表现（作者将其称为慢性视网膜坏死）的认识应促使对 CMV 进行分子检测，以确定适当的抗病毒治疗。鉴于新生血管并发症的高风险，还应考虑对此类眼睛进行预防性全视网膜光凝。
Purpose: To characterize a unique cytomegalovirus (CMV)-associated retinopathy in patients with limited immune dysfunction.Methods: Retrospective observational case series. CMV was confirmed as the pathogenic agent via polymerase chain reaction analysis of aqueous or vitreous humor samples or via immunohistochemical analysis of retinal biopsy specimens.Results: Five non-HIV patients with granular necrotizing retinitis, vitritis, and severe occlusive vasculopathy were identified. Patient histories all suggested a basis for limited immune dysfunction including advanced age (n = 4), diabetes mellitus (n = 4), and noncytotoxic immunotherapy (n = 3). Diagnosis of CMV retinitis was delayed in all cases and patients received either no antiviral therapy (n = 2) or incorrect antiviral therapy (n = 3) for presumed herpes simplex/varicella zoster-related acute retinal necrosis. Retinitis subsequently regressed in all cases with introduction of systemic ganciclovir/valganciclovir (n = 5) and/or intravitreal foscarnet (n = 2). Four of five patients developed neovascularization because of extensive retinal ischemia.Conclusion: The clinical expression of CMV-associated retinopathy is strongly related to immune status. In patients with limited immune dysfunction, a mixed clinical picture of intraocular inflammation with panretinal occlusive vasculopathy, more characteristic of acute retinal necrosis, and peripheral slowly progressive granular retinitis, more characteristic of classic CMV retinitis, is observed. Recognition of this atypical clinical presentation, which the authors term chronic retinal necrosis, should prompt molecular testing for CMV to determine the appropriate antiviral therapy. Consideration should also be given to prophylactic panretinal photocoagulation in such eyes, given the high risk of neovascular complications.