Abstract
Purpose
To assess the usefulness of spectral domain optical coherence tomography (SD-OCT) and fundus autofluorescence (FAF) findings in cytomegalovirus (CMV) retinitis.
Study design
Observational case series.
Methods
Thirteen eyes of 11 human immunodeficiency virus (HIV)-positive patients with CMV retinitis underwent full ophthalmologic examinations, SD-OCT, and 4 eyes of 4 patients underwent FAF. FAF images included short-wavelength autofluorescence (SW-AF) and near-infrared autofluorescence (IR-AF). CMV retinitis was classified into proposed categories of acute, subacute, remission, and recurrent; the acute stage was further subdivided into initial, early, and late stages.
Results
In the initial stage, vertical structural disruption of all retinal layers was observed by SD-OCT, and FAF showed hyperautofluorescence on SW-AF and hypoautofluorescence on IR-AF. In the early stage, SD-OCT showed significant retinal thickening; cells and debris from the retinal surface to the vitreous; enlarged vessels with/without thickened vessel walls; and highly complicated serous retinal detachment. In the late to subacute stage, features observed included rhegmatogenous retinal detachment with shrinking posterior hyaloid membrane and waving from the ellipsoid zone to the retinal pigment epithelium. In remission, FAF findings were hypoautofluorescence on SW-AF and hyperautofluorescence on IR-AF.
Conclusion
Although the number of examined eyes was limited, SD-OCT and FAF provide new information in various stages of CMV retinitis in patients with HIV infection that is not obtainable by conventional examination and which may be of great benefit when screening for the initial stage of CMV retinitis.
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References
Palella FJ Jr, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med. 1998;338:853–60.
Holland GN. AIDS and ophthalmology: the first quarter century. Am J Ophthalmol. 2008;145:397–408.
Holland GN, Buhles WC Jr, Mastre B, Kaplan HJ. A controlled retrospective study of ganciclovir treatment for cytomegalovirus retinopathy. Use of a standardized system for the assessment of disease outcome. Arch Ophthalmol. 1989;107:1759–66.
Wojtkowski M, Leitgeb RA, Kowalczyk A, Bajraszewski T, Fercher AF. In vivo human retinal imaging by Fourier domain optical coherence tomography. J Biomed Opt. 2002;7:457–63.
Cense B, Nassif NA, Chen TC, Pierce MC, Yun SH, Park BH, et al. Ultrahigh-resolution high-speed retinal imaging using spectral-domain optical coherence tomography. Opt Express. 2004;12:2435–47.
Wojtkowski M, Srinivasan VJ, Ko TH, Fujimoto JG, Kowalczyk A, Duker JS. Ultrahigh-resolution, high-speed, Fourier domain optical coherence tomography and methods for dispersion compensation. Opt Express. 2004;12:2404–22.
Leitgeb RA, Drexler W, Unterhuber A, Hermann B, Bajraszewski T, Le T, et al. Ultrahigh resolution Fourier domain optical coherence tomography. Opt Express. 2004;12:2156–65.
Freidlin J, Sharma MC, Goldstein DA. Subretinal hemorrhage in cytomegalovirus retinitis. Ophthalmic Surg Lasers Imaging. 2005;36:73–5.
Stewart MW, Brazis PW, Barrett KM, Eidelman BH, Mendez JC. Optical coherence tomography in a case of bilateral neuroretinitis. J Neuroophthalmol. 2005;25:131–3.
Miserocchi E, Modorati G, Brancato R. Immune recovery uveitis in an iatrogenically immunosuppressed patient. Eur J Ophthalmol. 2005;15:510–2.
Morrison VL, Kozak I, LaBree LD, Azen SP, Kayicioglu OO, Freeman WR. Intravitreal triamcinolone acetonide for the treatment of immune recovery uveitis macular edema. Ophthalmology. 2007;114:334–9.
Baker ML, Allen P, Shortt J, Lewin SR, Spencer A. Immune recovery uveitis in an HIV-negative individual. Clin Exp Ophthalmol. 2007;35:189–90.
Chan CK, Lin SG. Subfoveal choroidal neovascularization associated with cytomegalovirus retinitis and AIDS. Can J Ophthalmol. 2008;43:488–9.
Giani A, Sabella P, Eandi CM, Staurenghi G. Spectral-domain optical coherence tomography findings in a case of frosted retinal branch angiitis. Eye. 2010;24:943–4.
Costagliola C, Romano MR, Parmeggiani F, Dell’omo R, Cultrera R. Epiretinal membrane in a 12-year-old immunocompetent girl with cytomegalovirus infection. Eur J Ophthalmol. 2009;19:1099–102.
Sun LL, Goodwin T, Park JJ. Optical coherence tomography changes in macular CMV retinitis. Digit J Ophthalmol. 2012;18:1–4.
Park DH, Kim SY, Shin JP. Bilateral cytomegalovirus retinitis with unilateral optic neuritis in Good syndrome. Jpn J Ophthalmol. 2010;54:246–8.
Kurup SP, Khan S, Gill MK. Spectral domain optical coherence tomography in the evaluation and management of infectious retinitis. Retina. 2014;34:2233–41.
Brar M, Kozak I, Freeman WR, Oster SF, Mojana F, Yuson RM. Vitreoretinal interface abnormalities in healed cytomegalovirus retinitis. Retina. 2010;30:1262–6.
Yeh S, Forooghian F, Faia LJ, Weichel ED, Wong WT, Sen HN, et al. Fundus autofluorescence changes in cytomegalovirus retinitis. Retina. 2010;30:42–50.
Keilhauer CN, Delori FC. Near-infrared autofluorescence imaging of the fundus: visualization of ocular melanin. Invest Ophthalmol Vis Sci. 2006;47:3556–64.
Wohl DA, Kendall MA, Andersen J, Crumpacker C, Spector SA, Feinberg J, et al. Low rate of CMV end-organ disease in HIV-infected patients despite low CD4+ cell counts and CMV viremia: results of ACTG protocol A5030. HIV Clin Trials. 2009;10:143–52.
Takase H, Okada AA, Goto H, Mizuki N, Namba K, Ohguro N, et al. Development and validation of new diagnostic criteria for acute retinal necrosis. Jpn J Ophthalmol. 2015;59:14–20.
Mizushima D, Nishijima T, Yashiro S, Teruya K, Kikuchi Y, Katai N, et al. Diagnostic utility of quantitative plasma cytomegalovirus DNA PCR for cytomegalovirus end-organ diseases in patients with HIV-1 infection. J Acquir Immune Defic Syndr. 2015;68:140–6.
Jabs DA, Nussenblatt RB, Rosenbaum JT. Standardization of Uveitis Nomenclature (SUN) Working Group. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol. 2005;140:509–16.
Holland GN, Buhles WC Jr, Mastre B, Kaplan HJ. A controlled retrospective study of ganciclovir treatment for cytomegalovirus retinopathy. Use of a standardized system for the assessment of disease outcome. UCLA CMV Retinopathy. Study Group. Arch Ophthalmol. 1989;107:1759–66.
Nishijima T, Yashiro S, Teruya K, Kikuchi Y, Katai N, Oka S, Gatanaga H. Routine eye screening by an ophthalmologist is clinically useful for HIV-1-infected patients with CD4 count less than 200/μL. PLoS One. 2015;10:e0136747.
Kozak I, Bartsch DU, Cheng L, Freeman WR. In vivo histology of cotton-wool spots using high-resolution optical coherence tomography. Am J Ophthalmol. 2006;141:748–50.
Kozak I, Bartsch DU, Cheng L, Freeman WR. Hyperreflective sign in resolved cotton wool spots using high-resolution optical coherence tomography and optical coherence tomography ophthalmoscopy. Ophthalmology. 2007;114:537–43.
Gomez ML, Mojana F, Bartsch DU, Freeman WR. Imaging of long-term retinal damage after resolved cotton wool spots. Ophthalmology. 2009;116:2407–14.
Kashiwase M, Yamauchi Y, Sata T, Nagata Y, Usui N, Mochizuki M, et al. Histopathological findings in cytomegalovirus retinitis. Nippon Ganka Gakkai Zasshi. 2004;108:415–22 (in Japanese).
Rodrigues MM, Palestine A, Nussenblatt R, Masur H, Macher AM. Unilateral cytomegalovirus retinochoroiditis and bilateral cytoid bodies in a bisexual man with the acquired immunodeficiency syndrome. Ophthalmology. 1984;91:1577–82.
Pepose JS, Holland GN, Nestor MS, Cochran AJ, Foos RY. Acquired immune deficiency syndrome. Pathogenic mechanisms of ocular disease. Ophthalmology. 1985;92:472–84.
Bachman DM, Rodrigues MM, Chu FC, Straus SE, Cogan DG, Macher AM. Culture-proven cytomegalovirus retinitis in a homosexual man with the acquired immunodeficiency syndrome. Ophthalmology. 1982;89:797–804.
Keino H, Okada AA, Watanabe T, Echizen N, Inoue M, Takayama N, et al. Spectral-domain optical coherence tomography patterns in intraocular lymphoma. Ocul Immunol Inflamm. 2016;24:268–73.
Acknowledgements
This work was supported in part by a Grants-in-Aid for Research from the National Center for Global Health and Medicine (26A201). Professional medical English editing was provided by ThinkSCIENCE Inc., Tokyo, Japan.
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S. Yashiro, None; T. Nishijima, None; Y. Yamamoto, Grant (Santen Pharmaceutical’s Founder); Y. Sekine, None; N. Y. -Hata, None; T. Iida, Grant (Bayer Yakuhin, Canon, Kowa, Nidek, Novartis Pharma, Santen Pharmaceutical), Lecture fees (Bayer Yakuhin, Novartis Pharma, Santen Pharmaceutical); S. Oka, None.
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Yashiro, S., Nishijima, T., Yamamoto, Y. et al. Spectral domain optical coherence tomography and fundus autofluorescence findings in cytomegalovirus retinitis in HIV-infected patients. Jpn J Ophthalmol 62, 373–389 (2018). https://doi.org/10.1007/s10384-018-0574-9
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DOI: https://doi.org/10.1007/s10384-018-0574-9