Department of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan.
Viruses. 2024 Sep 7;16(9):1427. doi: 10.3390/v16091427.
Cytomegalovirus (CMV) retinitis is the most common eye disease associated with CMV infection in immunocompromised individuals. The CMVR may initially be asymptomatic; however, relatively mild vitreous inflammation at the onset may be an important differential point from other diseases in HIV patients. Fundus photography, CD4 T-cell count, and telemedicine could be used to screen and monitor the high-risk population, particularly in resource-limited regions. Retinitis generally starts in the peripheral retina and advances toward the posterior pole, which could develop to the characteristic "pizza pie" appearance marked by central retinal necrosis and intraretinal hemorrhage. CMVR causes vision loss if left untreated, and early antiviral therapy significantly reduces the risk of vision loss. Alongside traditional antiviral treatments, immunotherapies including CMV-specific adoptive T-cell therapy and CMV immunoglobulin (CMVIG) are emerging as promising treatment options due to their favorable tolerability and reduced mortality. This review comprehensively examines CMV retinitis, encompassing the clinical features, differential diagnosis, laboratory tests, and updated treatment strategies to inform clinical management.
巨细胞病毒（CMV）视网膜炎是免疫功能低下个体中与 CMV 感染相关的最常见眼部疾病。CMVR 最初可能无症状；然而，发病时相对轻微的玻璃体炎症可能是与 HIV 患者中其他疾病的重要鉴别点。眼底照相、CD4 T 细胞计数和远程医疗可用于筛查和监测高危人群，特别是在资源有限的地区。视网膜炎通常从周边视网膜开始，向眼底后极部发展，可能发展为具有特征性“披萨饼”外观，表现为中央视网膜坏死和视网膜内出血。CMVR 如果不治疗会导致视力丧失，早期抗病毒治疗可显著降低视力丧失的风险。除了传统的抗病毒治疗外，CMV 特异性过继性 T 细胞治疗和 CMV 免疫球蛋白（CMVIG）等免疫疗法因其良好的耐受性和降低的死亡率而成为有前途的治疗选择。本综述全面探讨了 CMV 视网膜炎，包括其临床特征、鉴别诊断、实验室检查以及更新的治疗策略，以指导临床管理。
