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Cytomegalovirus (CMV) Retinitis

Cytomegalovirus (CMV) Retinitis What is CMV Retinitis
Cytomegalovirus is a very common virus in the herpes family. 80% of adults carry antibodies to this virus, meaning they have been exposed to it at some point. The virus is not a threat to most of the population, as it is easily fought off by a healthy immune system. In immunocompromised individuals, however, the virus will sometimes attack the retina (the light-sensitive lining at the back of the eye), causing permanent vision loss.

Who is at risk?
AIDS patients have the highest risk of developing CMV retinitis, though anyone with a weakened immune system has some risk as well. Cancer patients undergoing chemotherapy are susceptible to opportunistic infections like CMV, as are patients on immunosuppressant drugs, such as those taken after an organ transplant or to control an autoimmune disease.

Symptoms
Symptoms of CMV retinitis often start in one eye, but then spread to the other. They may include:

  • Floaters
  • Blind spots
  • Blurred vision
  • Flashes of light
  • Decreased peripheral vision
  • Sudden vision loss

Seek immediate medical attention if you think you might have this disease. CMV retinitis can lead to retinal detachment and blindness in as little as two months if left untreated.

It is possible to have CMV retinitis with no symptoms. If you are at risk, especially if you have AIDS, see your eye doctor regularly to rule out this and other sight-threatening diseases.

Diagnosis and Treatment
CMV retinitis can be diagnosed as part of a comprehensive eye exam. Using pupil dilation and an indirect ophthalmoscope, your eye doctor can view the retina and look for any signs of damage. Further testing may include blood or urine tests or tissue biopsy. Fluorescein angiography may be performed to evaluate the blood supply to retina.

If you are diagnosed with CMV retinitis, you will likely be referred to a specialist who can better manage your initial treatment. The specialist may need to see you every two to four weeks until the disease is under control. After that, follow-up visits will be less frequent and you may be able to return to your regular eye doctor.

There is no cure for the disease; treatment can only slow its progression. Anti-viral medications used to treat CMV retinitis include ganciclovir, foscarnet, cidofovir, and fomivirsen. Drugs may be given intravenously, orally, as an injection into the eye, or via an implant which is inserted into the eye.

Unfortunately, these drugs can sometimes have serious side-effects. Foscarnet can cause kidney damage; Ganciclovir can lower white blood cell count, which may be a serious concern since the patient is already immunocompromised. Your eye doctor will evaluate your specific situation to determine the best course of treatment for you.

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