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Mayuko Tsuda, Hiroshi Keino, Makiko Nakayama, Masayoshi Ando, Takayo Watanabe, Annabelle A Okada; Compromised optic nerve head blood flow in cytomegalovirus retinitis. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4181.
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© ARVO (1962-2015); The Authors (2016-present)
Cytomegalovirus retinitis (CMV) retinitis is a posterior uveitis in patients with severe immunosuppression. The purpose of this study was to evaluate optic nerve head (ONH) blood flow changes over the course of treatment of CMV retinitis using laser speckle flowgraphy (LSFG).
Clinical records of 4 eyes of 3 patients with CMV retinitis were retrospectively reviewed. One patient had human immunodeficiency virus (HIV) infection (case 1), one patient had dermatomyositis (case 2), and one patient had Good syndrome (case 3). Two patients (cases 1 and 2) had unilateral and 1 patient (case 3) had bilateral retinitis. To evaluate ONH blood flow levels, mean blur rate (MBR), representative of relative blood flow velocity, was measured by LSFG in affected and unaffected eyes over follow-up.
The median age was 53 years (42-74 years), and the median follow-up period was 12 months (10-24 months). CMV was detected by polymerase chain reaction testing in aqueous humor samples from all patients. Two eyes had zone 1 disease, (cases 1 and 3), 1 eye had zone 2 disease (case 3), and 1 eye had zone 3 disease (case 2). All patients received intravitreal injections of ganciclovir and one patient (case 1) was treated with intravenous ganciclovir. Antiretroviral therapy was also started in one patient (case 1). All 4 eyes showed improvement in the ocular findings with treatment, and no retinal detachments were observed over the follow-up period. The mean ONH MBR in eyes with CMV retinitis was 19.9±6.8 at baseline (n = 4), 21.2±5.5 at 1 month (M) (n = 4), 24.2±11.1 at 3M (n = 4), and 24.0±9.1 at 6M (n = 4), whereas the mean ONH MBR in unaffected eyes was 39.2±3.6 at baseline (n = 2), 43.5±1.2 at 1M (n = 2), 36.7±2.5 at 3M (n = 2), and 39.3±3.6 at 6M (n = 2). The mean ONH MBR was significantly reduced in eyes with CMV retinitis compared to unaffected eyes at baseline and at 1M, but there was no significant difference at 3M and 6M. The ONH MBR in 2 eyes with zone 1 disease was 20.5 and 10.2 at baseline, whereas the ONH MBR was 23.2 in one eye with zone 2 disease, and 25.8 in one eye with zone 3 disease.
The present study demonstrates marked reduction of ONH blood flow velocity in eyes with CMV retinitis at baseline and at 1M after initiation of CMV retinitis treatment. Further investigations are required to delineate the clinical significance of compromised ONH blood flow levels in CMV retinitis.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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