Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Am J Ophthalmol. 2012 May;153(5):923-931.e1. doi: 10.1016/j.ajo.2011.10.012. Epub 2012 Jan 20.
To characterize the clinical manifestations of cytomegalovirus (CMV) retinitis in northern Thailand.
Prospective, observational, cross-sectional study.
We recorded characteristics of 52 consecutive patients newly diagnosed with CMV retinitis at a tertiary university-based medical center in northern Thailand. Indirect ophthalmoscopy by experienced ophthalmologists was supplemented with fundus photography to determine the proportion of eyes with various clinical features of CMV retinitis.
Of the 52 patients with CMV retinitis, 55.8% were female. All were HIV-positive. The vast majority (90.4%) had started antiretroviral therapy. CMV retinitis was bilateral in 46.2% of patients. Bilateral visual acuity worse than 20/60 was observed in 23.1% of patients. Of 76 eyes with CMV retinitis, 61.8% had zone I disease and 21.6% had lesions involving the fovea. Lesions larger than 25% of the retinal area were observed in 57.5% of affected eyes. CMV retinitis lesions commonly had marked or severe border opacity (47.4% of eyes). Vitreous haze often was present (46.1% of eyes). Visual impairment was more common in eyes with larger retinitis lesions. Retinitis lesion size, used as a proxy for duration of disease, was associated with fulminant appearance (odds ratio, 1.24; 95% confidence interval, 1.01 to 1.51) and marked or severe border opacity (odds ratio, 1.36; 95% confidence interval, 1.11 to 1.67). Based on lesion size, retinitis preceded antiretroviral treatment in each patient.
Patients seeking treatment at a tertiary medical center in northern Thailand had advanced CMV retinitis, possibly because of delayed diagnosis. Earlier screening and treatment of CMV retinitis may limit progression of disease and may prevent visual impairment in this population.
描述泰国北部巨细胞病毒（CMV）视网膜炎的临床表现。
前瞻性、观察性、横断面研究。
我们记录了在泰国北部一家三级大学附属医院新诊断为 CMV 视网膜炎的 52 例连续患者的特征。有经验的眼科医生通过间接检眼镜检查，并结合眼底照相，确定 CMV 视网膜炎各临床特征的眼数比例。
52 例 CMV 视网膜炎患者中，55.8%为女性。所有患者均为 HIV 阳性。绝大多数（90.4%）已开始接受抗逆转录病毒治疗。46.2%的患者 CMV 视网膜炎为双侧性。23.1%的患者双侧视力低于 20/60。76 只患眼的 CMV 视网膜炎中，61.8%为 I 区疾病，21.6%累及黄斑。57.5%受影响眼中病变面积大于 25%视网膜面积。CMV 视网膜炎病变常有明显或严重的边界混浊（47.4%的眼）。玻璃体混浊常存在（46.1%的眼）。视力损害在视网膜炎病变较大的眼中更为常见。视网膜炎病变大小（用作疾病持续时间的替代指标）与暴发性外观（比值比，1.24；95%置信区间，1.01 至 1.51）和明显或严重的边界混浊（比值比，1.36；95%置信区间，1.11 至 1.67）相关。根据病变大小，每位患者的视网膜炎均先于抗逆转录病毒治疗。
在泰国北部的一家三级医疗中心就诊的患者患有晚期 CMV 视网膜炎，可能是因为诊断延迟。对 CMV 视网膜炎进行更早的筛查和治疗可能会限制疾病的进展，并可能防止该人群视力受损。
