CMV Retinitis: The Diagnostic Challenges and Long-Term Outcomes. The Experience of Tertiary Eye Center in Saudi Arabia

Abstract Purpose To describe the clinical features, complications, and long-term visual outcomes of cytomegalovirus (CMV) retinitis in patients presenting to a tertiary eye center. Methods A retrospective chart review of patients who were diagnosed with CMV retinitis between 2014 and 2024. Results Twelve eyes of 8 patients were included. Five patients (62.5%) were males and 3 (37.5%) were females. All patients were immunocompromised. Four patients (40%) were on immunosuppressive medications after renal transplantations for chronic renal failure (CRF), three patients had human immunodeficiency virus (HIV) infections, and one patient had a congenital immunodeficiency disease. The baseline best-corrected visual acuity (BCVA) was 0.8 ± 0.9 (Snellen = 20/125). Seven eyes (58.3%) had a hemorrhagic type of retinitis, and 5 eyes had granular retinitis (41.7%). Vitritis was found only in 2 eyes (16.7%), vasculitis was found in 3 eyes (25%), and occlusive vasculitis was found in 2 eyes (16.7%), and all of these features were present in patients who were non-HIV infected. The mean BCVA on the last visit was 0.9 ± 1.2 (Snellen = 20/160). Visual threatening complications included macular atrophy, optic disc pallor, rhegmatogenous retinal detachment (RRD), and NVG. Conclusion The clinical picture of CMV retinitis is better related to the level of immunity than the classification of HIV vs non-HIV related. Signs of inflammatory response were absent in HIV-infected patients.