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J. D. Keenan, S. Ausayakhun, S. Ausayakhun, C. Jirawison, C. Khouri, A. Skalet, D. Heiden, G. Holland, T. Margolis; Clinical Features of CMV Retinitis in Chiang Mai, Thailand. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2894.
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Although CMV retinitis is uncommon in much of the world, it remains an important cause of blindness in Southeast Asia. Here, we describe the clinical features of CMV retinitis from a referral center in Northern Thailand.
In a cross-sectional study, 94 consecutive patients with HIV seen in 2008-09 at the Chiang Mai University ocular infectious disease clinic were interviewed and examined by an attending ophthalmologist during their initial visit using a uniform data form.
Out of 94 patients, 59 (63%) were diagnosed with CMV retinitis. Of the patients with CMV retinitis, 49% had bilateral disease and 51% unilateral disease; 51% were female, and the mean age was 39.2 (± 7.5). The majority (53 of 59; 90%) had started antiretroviral therapy. 43 patients with CMV retinitis reported information about their current CD4 count; of these, 63% had a CD4 <50, and 74% had a CD4 <100. All patients with a CD4 ≥50 were taking antiretroviral therapy, for a median of 188 days. Out of the 188 eyes examined, CMV retinitis was present in 88 eyes (47%), absent in 93, and could not be determined in 7. In the 88 eyes with CMV retinitis, 26% were classified as low vision (best corrected visual acuity worse than 20/60 but better than or equal to 20/400), and 30% as blind (best corrected visual acuity worse than 20/400). Of the 59 patients with CMV retinitis, 7% were bilaterally blind. Of the 88 eyes with CMV retinitis, retinitis was present in zone 1 in 61%, in zone 2 in 81%, and in zone 3 in 77%; CMV retinitis was classified as active in 73 eyes (83%). Vitreous haze was present in 42 of 88 eyes (48%), with a median vitreous haze score of 1+ (range 1+ to 4+). Retinal detachment was present in 5 eyes.
At a referral center in northern Thailand, CMV retinitis often presents as severe disease, with almost one-third of eyes blind, and frequent bilateral and posterior pole disease. Retinitis was common, even though most patients had already started antiretroviral therapy by the time of ophthalmologic consultation. Screening for CMV retinitis is important in this population.
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