Yoshinaga Wakako, Mizushima Yuka, Abematsu Noriko, Nakao Kumiko, Sakamoto Taiji
Department of Ophthalmology Kagoshima University Graduate School of Medical and Dental Sciences, Japan.
Nippon Ganka Gakkai Zasshi. 2008 Aug;112(8):684-7.
Cytomegalovirus (CMV) retinitis usually affects severely immunosuppressed individuals. We report two immunocompetent patients who developed CMV retinitis.
Case 1 was a 65-year-old man who was referred to us with blurred vision and floaters of 2 weeks duration in his left eye. Slit-lamp biomicroscopy showed keratic precipitates, aqueous cells, and vitreous opacity in his left eye. Funduscopic examination revealed yellow-white retinal lesions with arterial sheathing in the superotemporal midperiphery. Case 2 was a 63-year-old man who presented with a 2-week history of blurred vision in his left eye. Ophthalmologic examination of the left eye showed keratic precipitates, aqueous cells, vitreous opacity, and yellow-white lesions in the superotemporal peripheral retina. In both cases, CMV DNA was detected in the aqueous humor and therefore the diagnosis was CMV retinitis. CMV retinitis in both cases was indolent and was resolved in one month without treatment with antiviral drugs. Although both patients had diabetes mellitus, the results of their laboratory examinations were unremarkable and they were immunocompetent.
Unlike CMV retinitis in immunocompromised patients, CMV retinitis in immunocompetent patients had significant anterior and vitreous inflammation but did not require antiviral treatment. A possible association between CMV retinitis and diabetes mellitus was suggested.
巨细胞病毒（CMV）视网膜炎通常影响严重免疫抑制的个体。我们报告了两名免疫功能正常的患者发生了CMV视网膜炎。
病例1是一名65岁男性，因左眼视力模糊和飞蚊症2周前来就诊。裂隙灯生物显微镜检查显示其左眼有角膜后沉着物、房水细胞和玻璃体混浊。眼底检查发现颞上中周边部有黄白色视网膜病变伴动脉鞘。病例2是一名63岁男性，左眼视力模糊2周。左眼眼科检查显示有角膜后沉着物、房水细胞、玻璃体混浊以及颞上周边视网膜黄白色病变。在这两个病例中，房水中均检测到CMV DNA，因此诊断为CMV视网膜炎。两个病例的CMV视网膜炎均呈惰性，未经抗病毒药物治疗在1个月内消退。尽管两名患者均患有糖尿病，但其实验室检查结果无异常，且免疫功能正常。
与免疫功能低下患者的CMV视网膜炎不同，免疫功能正常患者的CMV视网膜炎有明显的前部和玻璃体炎症，但无需抗病毒治疗。提示CMV视网膜炎与糖尿病之间可能存在关联。
