Abstract
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.
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Eid AJ, Bakri SJ, Kijpittayarit S, Razonable RR . Clinical features and outcomes of cytomegalovirus retinitis after transplantation. Transplant Infect Dis 2008; 10: 13–18.
Karavellas MP, Azen SP, MacDonald JC, Shufelt CL, Lowder CY, Plummer DJ et al. Immune recovery vitritis and uveitis in AIDS; clinical predictors, sequelae and treatment outcomes. Retina 2001; 21: 1–9.
Smith IL, Macdonald JC, Freeman WR, Shapiro AM, Spector SA . Cytomegalovirus (CMV) retinitis activity is accurately reflected by the presence and level of CMV DNA in aqueous humor and vitreous. J Infect Dis 1999; 179: 1249–1253.
Musch DC, Martin DF, Gordon JF, Davis MD, Kuppermann BD, Ganciclovir Implant Study Group. Treatment of cytomegalovirus retinitis with a sustained-release ganciclovir implant. N Engl J Med 1997; 337: 83–90.
Martin DF, Sierra-Madero J, Walmsley S, Wolitz RA, Macey K, Georgiou P . A controlled trial of valganciclovir as induction therapy for cytomegalovirus retinitis. N Engl J Med 2002; 346: 1119–1126.
van Boxtel LA, van der Lelij A, van der Meer J, Los LI . Cytomegalovirus as a cause of anterior uveitis in immunocompetent patients. Ophthalmology 2007; 114: 1358–1362.
Koizumi N, Suzuki T, Uno T, Chihara H, Shiraishi A, Hara Y et al. CMV as an etiologic factor in corneal endotheliitis. Ophthalmology 2008; 115: 292–297.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The author declares no conflict of interest.
Additional information
Based on a presentation at the 2011 Cambridge Ophthalmology Symposium.
Rights and permissions
About this article
Cite this article
Carmichael, A. Cytomegalovirus and the eye. Eye 26, 237–240 (2012). https://doi.org/10.1038/eye.2011.327
Received:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/eye.2011.327
Keywords
This article is cited by
-
Retinitis after haematopoietic stem cell transplantation with multiple intraocular viral infections (cytomegalovirus, Epstein‒Barr virus and herpes simplex virus)- a case report
BMC Ophthalmology (2024)
-
The Infectious Uveitis Treatment Algorithm Network (TITAN) Report 2—global current practice patterns for the management of Cytomegalovirus anterior uveitis
Eye (2024)
-
Cytomegalovirus anterior uveitis and occlusive retinal vasculitis without retinitis in a patient on immunomodulatory therapy
Journal of Ophthalmic Inflammation and Infection (2023)
-
CMV retinitis and subsequent acute cystoid macular oedema after treatment with vitreous ganciclovir injection: a case report
BMC Ophthalmology (2022)
-
Management of cytomegalovirus corneal endotheliitis
Eye and Vision (2021)
