Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
JAMA Ophthalmol. 2013 May;131(5):638-45. doi: 10.1001/jamaophthalmol.2013.2860.
Little attention has been paid to clinical features of cytomegalovirus (CMV) infections in individuals without human immunodeficiency virus (HIV).
To describe the clinical manifestations and comorbidities of patients without HIV infection who have CMV-associated posterior uveitis or panuveitis.
Retrospective observational case series in an academic research setting.
The medical records were reviewed of 18 patients (22 affected eyes) diagnosed as having posterior uveitis or panuveitis who had aqueous positive for CMV by polymerase chain reaction techniques.
Demographic data, clinical manifestations, and associated systemic diseases were recorded.
Ocular features included focal hemorrhagic retinitis (n = 13) and peripheral retinal necrosis (n = 7). Two eyes had no focal retinal lesions but manifested vasculitis and vitritis. All patients exhibited vitreous inflammation. Inflammatory reactions in anterior segments developed in 14 of 22 eyes (64%). Retinal vasculitis was observed in 16 of 22 eyes (73%) and included mostly arteries (in 13 of 16 eyes [81%]). Eleven of 18 patients were taking immunosuppressive medications (5 for hematologic malignant diseases, 4 for systemic autoimmune diseases, and 2 following organ transplants). One additional patient was diagnosed as having non-Hodgkin lymphoma 3 months after the onset of CMV-associated panuveitis, and another patient had primary immunodeficiency disorder. Of the remaining 5 patients, 2 had diabetes mellitus, and 3 had no associated systemic diseases and exhibited no evidence of immune deficiency.
Cytomegalovirus-associated infections of posterior eye segments can develop in patients without HIV infection who have compromised immune function of variable severity but may occur also in individuals who have no evidence of immune insufficiency. Cytomegalovirus infections located in posterior eye segments in patients without HIV infection caused intraocular inflammatory reaction in all cases and demonstrated more variable clinical presentation than classic CMV retinitis observed in patients with HIV infection.
人们对没有人类免疫缺陷病毒（HIV）的个体中巨细胞病毒（CMV）感染的临床特征关注甚少。
描述没有 HIV 感染但患有 CMV 相关后部葡萄膜炎或全葡萄膜炎的患者的临床表现和合并症。
在学术研究环境中进行的回顾性观察性病例系列研究。
回顾性分析了 18 名（22 只受影响的眼睛）患者的病历，这些患者通过聚合酶链反应技术诊断为 CMV 相关的后部葡萄膜炎或全葡萄膜炎，眼内液呈 CMV 阳性。
记录人口统计学数据、临床表现和相关的系统性疾病。
眼部特征包括局灶性出血性视网膜炎（n=13）和周边视网膜坏死（n=7）。两只眼睛没有局灶性视网膜病变，但表现为血管炎和玻璃体炎。所有患者均表现为玻璃体炎症。22 只眼中有 14 只（64%）出现前节炎症反应。22 只眼中有 16 只（73%）观察到视网膜血管炎，其中大部分为动脉（13 只眼中有 16 只[81%]）。18 名患者中有 11 名（5 名患有血液恶性肿瘤疾病，4 名患有系统性自身免疫性疾病，2 名接受过器官移植）正在服用免疫抑制药物。另一名患者在 CMV 相关性全葡萄膜炎发病后 3 个月被诊断为非霍奇金淋巴瘤，另一名患者患有原发性免疫缺陷症。其余 5 名患者中，2 名患有糖尿病，3 名无系统性疾病，也没有免疫缺陷的证据。
免疫功能受损程度不同的没有 HIV 感染的患者可能会发生后部眼部节段的 CMV 相关感染，但也可能发生在没有免疫不足证据的个体中。没有 HIV 感染的后部眼部节段的 CMV 感染导致所有患者的眼内炎症反应，并表现出比 HIV 感染患者中观察到的典型 CMV 视网膜炎更具变异性的临床表现。
