Retinal detachment and mortality in patients with cytomegalovirus retinitis: A multicenter study in taiwan

Po-Yi Wu; Eugene Yu-Chuan Kang; Wei-Dar Chen; Sunir J Garg; Wei-Yu Chiang; Ming-Hsun Lee; Hung-Da Chou; Nan-Kai Wang; An-Ning Chao; Kuan-Jen Chen; Wei-Chi Wu; Yih-Shiou Hwang

doi:10.1007/s00417-024-06651-2

Retinal detachment and mortality in patients with cytomegalovirus retinitis: A multicenter study in taiwan

Graefes Arch Clin Exp Ophthalmol. 2024 Oct 18. doi: 10.1007/s00417-024-06651-2. Online ahead of print.

Authors

Po-Yi Wu^{1

2}, Eugene Yu-Chuan Kang^{3

4

5

6}, Wei-Dar Chen^{7

8}, Sunir J Garg⁹, Wei-Yu Chiang^{7

10}, Ming-Hsun Lee^{7

11}, Hung-Da Chou^{1

7}, Nan-Kai Wang^{1

7

12}, An-Ning Chao^{1

7}, Kuan-Jen Chen^{1

7}, Wei-Chi Wu^{1

7}, Yih-Shiou Hwang^{13

14

15}

Affiliations

¹ Department of Ophthalmology, Linkou Medical Center, Chang Gung Memorial Hospital, No. 5, Fu Shin St, Kuei-Shan, Taoyuan, 333, Taiwan.
² School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
³ Department of Ophthalmology, Linkou Medical Center, Chang Gung Memorial Hospital, No. 5, Fu Shin St, Kuei-Shan, Taoyuan, 333, Taiwan. yckang0321@gmail.com.
⁴ College of Medicine, Chang Gung University, Taoyuan, Taiwan. yckang0321@gmail.com.
⁵ Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan. yckang0321@gmail.com.
⁶ Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA. yckang0321@gmail.com.
⁷ College of Medicine, Chang Gung University, Taoyuan, Taiwan.
⁸ Department of Ophthalmology, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.
⁹ MidAtlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA.
¹⁰ Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
¹¹ Division of Infectious Diseases, Department of Internal Medicine, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
¹² Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA.
¹³ Department of Ophthalmology, Linkou Medical Center, Chang Gung Memorial Hospital, No. 5, Fu Shin St, Kuei-Shan, Taoyuan, 333, Taiwan. yihshiou.hwang@gmail.com.
¹⁴ College of Medicine, Chang Gung University, Taoyuan, Taiwan. yihshiou.hwang@gmail.com.
¹⁵ Department of Ophthalmology, Jen-Ai Hospital Dali Branch, Taichung, Taiwan. yihshiou.hwang@gmail.com.

PMID: 39422751
DOI: 10.1007/s00417-024-06651-2

Abstract

Purpose: To characterize patients with cytomegalovirus (CMV) retinitis and identify risk factors for retinal detachment (RD) and mortality in this Taiwanese patient population.

Methods: This retrospective study included patients diagnosed with CMV retinitis between 2007 and 2019. The diagnosis was confirmed through aqueous polymerase chain reaction (PCR). Relevant data were collected from the Chang Gung Research Database. Univariate Cox regression was performed to identify the associations of RD and mortality risks with various patient characteristics, including demographic features, comorbidities, laboratory results, and medication use patterns.

Results: In total, 32 patients with CMV retinitis were included. Among these patients, 78.1% had an immunocompromised status, including 56.3% with high-dose systemic steroid use, 21.9% with HIV infection, 12.5% with hematologic malignancy, and 9.4% with renal transplantation. Approximately 21.9% of patients had RD 2.4 ± 2.1 months after CMV retinitis diagnosis, and 34.4% died within 6.2 [4.2, 38.2] months after diagnosis. Patients with RD had a statistically significant, but likely not clinically significant, later initiation of anti-CMV medications compared to their non-RD counterparts (8 [5, 23] days vs. 2 [1, 11] days, p = 0.039). Mortality was significantly associated with older age (hazard ratio [HR]: 1.06; 95% confidence interval [CI]: 1.02-1.10), hematologic malignancy (HR: 5.92; 95% CI: 1.44-24.37), and positivity for CMV on blood PCR (HR: 4.93; 95% CI: 1.49-16.35).

Conclusion: Our study suggests that older age, hematologic malignancy, and positivity for CMV on blood PCR are risk factors for mortality in patients with CMV retinitis.

Key messages: What is known Cytomegalovirus (CMV) retinitis is the predominant sight-threatening opportunistic ocular infection in patients with acquired immunodeficiency syndrome (AIDS). What is new In the era of highly active antiretroviral therapy for AIDS, the majority of CMV retinitis patients are those receiving immunomodulatory therapy for underlying diseases. Older age, hematologic malignancy, and positive blood polymerase chain reaction for CMV are potential risk factors for mortality in patients with CMV retinitis.

Keywords: Cytomegalovirus; Immunosuppression; Polymerase chain reaction; Retinal detachment; Retinitis.