Infectious Diseases Service, Addenbrooke's Hospital, Cambridge, UK.
Eye (Lond). 2012 Feb;26(2):237-40. doi: 10.1038/eye.2011.327. Epub 2011 Dec 16.
Following primary infection, cytomegalovirus (CMV) establishes latent infection in myeloid progenitor cells and intermittent viral reactivation from activated macrophages or dendritic cells, which is brought under control by strong virus-specific CD4+ T-cell and CD8+ T-cell responses. CMV retinitis characterized by spreading retinal necrosis due to viral cytopathic effect occurs in patients who have impaired T-cell function as a result of transplantation, AIDS, or immuno-suppressive treatment. The diagnosis of CMV retinitis can be confirmed by PCR amplification of viral DNA in aqueous. When administered intravenously, the antiviral drugs Ganciclovir and Foscarnet have modest penetration into the vitreous compared with direct intra-vitreal injection. In randomized trials of HIV-associated CMV retinitis, a Ganciclovir implant was consistently superior to intravenous Ganciclovir in preventing progression of retinitis. CMV is also implicated in two forms of anterior segment disease in immuno-competent adults, namely CMV anterior uveitis and CMV corneal endotheliitis.
原发性感染后,巨细胞病毒 (CMV) 在髓系祖细胞中建立潜伏感染,并在激活的巨噬细胞或树突状细胞中间歇性病毒再激活,这一过程受到强大的病毒特异性 CD4+T 细胞和 CD8+T 细胞反应的控制。CMV 视网膜炎的特征是由于病毒细胞病变作用导致视网膜坏死扩散,发生于因移植、艾滋病或免疫抑制治疗而导致 T 细胞功能受损的患者中。CMV 视网膜炎的诊断可以通过在房水中扩增病毒 DNA 来确认。与直接玻璃体内注射相比,抗病毒药物更昔洛韦和膦甲酸在玻璃体内的穿透性较差,当静脉内给药时。在 HIV 相关 CMV 视网膜炎的随机试验中,与静脉内更昔洛韦相比,更昔洛韦植入物始终能更好地预防视网膜炎进展。CMV 还与免疫功能正常的成年人的两种前节疾病有关,即 CMV 前葡萄膜炎和 CMV 角膜内皮炎。
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