Arch Ophthalmol. 1996 Jul;114(7):848-55.
To illustrate 2 common problems encountered in evaluating the response of cytomegalovirus retinitis to antiviral treatment and to consider their clinical importance.
Four illustrative cases were selected from 76 cases reviewed during a study that compared clinical evaluation and centralized grading of fundus photographs in the assessment of cytomegalovirus retinitis.
These cases illustrate 2 problems noted during the review: (1) that progression of retinitis may be difficult to recognize clinically in the absence of an obvious increase in retinitis border activity and (2) that movement of retinitis borders by 750 microns or more (the principal criterion used to define retinitis progression) during the initial 4 weeks of treatment does not necessarily represent an unfavorable response to treatment.
Ophthalmologists who participate in the management of cytomegalovirus retinitis should be aware of the subtlety of retinitis activity that sometimes accompanies progression in patients undergoing treatment with currently approved agents. Side-by-side comparison of good-quality photographs from the current visit (as soon as they are available) with photographs from previous visits, using adequate illumination and magnification, may be helpful in detecting progression promptly. When applying the results of clinical trials to clinical practice, clinicians should not equate retinitis border movement of 750 microns or more during the first 4 weeks of treatment with treatment failure.
阐述在评估巨细胞病毒性视网膜炎对抗病毒治疗的反应时遇到的两个常见问题，并探讨其临床重要性。
从一项研究中回顾的76例病例中选取4例进行说明，该研究比较了临床评估和眼底照片集中分级在巨细胞病毒性视网膜炎评估中的作用。
这些病例说明了回顾过程中发现的两个问题：（1）在视网膜病变边界活动没有明显增加的情况下，视网膜病变的进展在临床上可能难以识别；（2）在治疗的最初4周内，视网膜病变边界移动750微米或更多（用于定义视网膜病变进展的主要标准）并不一定代表对治疗的不良反应。
参与巨细胞病毒性视网膜炎管理的眼科医生应意识到，在用目前批准的药物治疗的患者中，视网膜病变活动有时会伴随病变进展，具有一定的隐匿性。将此次就诊（照片一拿到手）的高质量照片与之前就诊的照片并排比较，使用足够的照明和放大倍数，可能有助于及时发现病变进展。在将临床试验结果应用于临床实践时，临床医生不应将治疗前4周内视网膜病变边界移动750微米或更多等同于治疗失败。
