Eid A J, Bakri S J, Kijpittayarit S, Razonable R R
Division of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
Transpl Infect Dis. 2008 Feb;10(1):13-8. doi: 10.1111/j.1399-3062.2007.00241.x. Epub 2007 May 19.
Cytomegalovirus (CMV) infection of the retina is a rarely encountered end-organ disease after transplantation. In order to describe the clinical characteristics and outcomes of CMV retinitis after hematopoietic stem cell and solid organ transplantation, we performed a retrospective review of all cases of CMV retinitis at the Mayo Clinic (Rochester, Minnesota) during 1990-2004. During this 15-year period, CMV retinitis was diagnosed in 14 eyes of 9 patients who had received kidney (n=5), liver (n=2), heart (n=1), and autologous hematopoietic stem cell transplant (n=1). The mean age of the patients was 58 (standard deviation+/-11) years; 6 were male. The median time to diagnosis of CMV retinitis was 9 months (range, 4 months to 13 years) after transplantation. Four (44%) patients had concomitant pneumonitis or hepatitis. Five (55%) patients had bilateral retinitis. Retinal involvement was <or=10% in 8 eyes, >10% but <or=50% in 4 eyes, and >50% in 2 eyes. All patients received induction therapy with intravenous ganciclovir (n=8) or foscarnet (n=1) for a median of 43 days (range, 14-100 days) followed by maintenance therapy with intravenous or oral ganciclovir for a median of 88 days (range, 36-943 days) in 6 (67%) patients. One patient developed bilateral immune recovery uveitis during treatment, and later on progressed to develop rhegmatogenous retinal detachment. During the mean follow-up period of 20 months, visual acuity improved in 4 (28.5%), was stable in 4 (28.5%), and worsened in 6 (43%) eyes. CMV retinitis recurred in 2 patients. In conclusion, CMV retinitis is a rare, progressive, and highly morbid infectious complication of transplantation. The severity of clinical disease at the time of diagnosis may predict poor outcome. Hence, early intervention may be crucial to prevent its progression to irreversible visual loss.
视网膜巨细胞病毒（CMV）感染是移植后罕见的终末器官疾病。为了描述造血干细胞移植和实体器官移植后CMV视网膜炎的临床特征及转归，我们对梅奥诊所（明尼苏达州罗切斯特）1990年至2004年期间所有CMV视网膜炎病例进行了回顾性研究。在这15年期间，9例接受肾移植（n = 5）、肝移植（n = 2）、心脏移植（n = 1）和自体造血干细胞移植（n = 1）的患者的14只眼睛诊断为CMV视网膜炎。患者的平均年龄为58岁（标准差±11）；6例为男性。诊断CMV视网膜炎的中位时间为移植后9个月（范围4个月至13年）。4例（44%）患者合并肺炎或肝炎。5例（55%）患者为双侧视网膜炎。8只眼睛的视网膜受累≤10%，4只眼睛的视网膜受累>10%但≤50%，2只眼睛的视网膜受累>50%。所有患者均接受静脉注射更昔洛韦（n = 8）或膦甲酸钠（n = 1）诱导治疗，中位时间为43天（范围14 - 100天），随后6例（67%）患者接受静脉或口服更昔洛韦维持治疗，中位时间为88天（范围36 - 943天）。1例患者在治疗期间发生双侧免疫恢复性葡萄膜炎，随后进展为孔源性视网膜脱离。在平均20个月的随访期内，4只眼睛（28.5%）视力改善，4只眼睛（28.5%）视力稳定，6只眼睛（43%）视力恶化。2例患者CMV视网膜炎复发。总之，CMV视网膜炎是一种罕见、进行性且具有高度致病性的移植感染并发症。诊断时临床疾病的严重程度可能预示预后不良。因此，早期干预对于防止其进展为不可逆视力丧失可能至关重要。
