Acta Scientific Ophthalmology (ASOP)

Case Report Volume 3 Issue 3

R Hegmatogenous Retinal Detachment in Cytomegalovirus Retinitis in A Post Liver Transplant-Immunocompromised Patient: Clinical and Anatomical Features and Visual Outcomes

Adel Alakeely*, Abdulaziz Alageely and Eman AlKahtani

King Khaled Eye Specialist Hospital, Saudi Arabia

*Corresponding Author:Adel Alakeely, King Khaled Eye Specialist Hospital, Saudi Arabia.

Received: January 20, 2020; Published: February 27, 2020

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  Cytomegalovirus (CMV) infection is a common viral infection in non-HIV immunocompromised posttransplant patients, which causes significant morbidity and mortality. We present a rare case of Isolated CMV retinitis in a non-HIV immunocompromised patient 7 years after a liver transplant. The 58-year-old patient was on Cell cept (mycophenolate mofetil), Tacrolimus, and Entecavir, and presented with decreased vision and floaters in the right eye. Vision in the right eye was 20/40, while examination revealed mild uveitis, retinitis, and a foveal-sparing subretinal detachment. The patient underwent a pars plana vitrectomy (PPV) with silicone oil, endolaser, and intravitreal Ganciclovir, with the silicone oil removed 10 months later. The patient's best corrected visual acuity (VA) was 20/60 in the affected eye 12 months after surgery. We speculate that his use of prophylactic Entecavir may have played a role in this unique clinical picture. We assume that the positive visual outcome was due to good VA at presentation, secondary to foveal-sparing retinal detachment (RD); this entailed the use of intravitreal ganciclovir injection after surgery with systemic Ganciclovir, close follow-up, and planning surgical steps prior to the intervention.

Conclusion: Careful surgical planning with the use of intravitreal ganciclovir injection after surgery and systemic Ganciclovir may improve the visual outcome in such presentation.

Keywords: Retinal Detachment; Pars Plana Vitrectomy; Cytomegalovirus Retinitis; Liver Transplant; Immunocompromised

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References

  1. K Mwintshi and DC Brennan. “Prevention and management of cytomegalovirus infection in solid-organ transplantation”. Expert Review Anti-Infectious Therapy 5.2 (2007): 295-304.
  2. A J Eid., et al. “Clinical features and outcome of cytomegalovirus retinitis after transplantation”. Transplant Infectious Disease 10.1 (2008): 13-18.
  3. WR Freeman., et al. “Risk factors for development of rhegmatogenous retinal detachment in patients with cytomegalovirus retinitis”. American Journal Ophthalmology 116.6 (1993): 713-20.
  4. R Singh., et al. “Outcome of surgery in post-cytomegalovirus retinal detachment: experience before and in the era of highly active anti-retroviral therapy in Indian eyes”. Indian Journal Ophthalmology 61. 11 (2013): 636-639.
  5. L Lu., et al. “Long-term follow-up of cytomegalovirus retinitis in non-HIV immunocompromised patients: clinical features and visual prognosis”. American Journal of Ophthalmology 165.1 (2016): 145-153. 
  6. A Egli., et al. “Cytomegalovirus-associated chorioretinitis after liver transplantation: case report and review of the literature”. Transplantation Infectious Disease 10.1 (2008): 27-43.
  7. L Hambach., et al. “Increased risk of complicated CMV infection with the use of mycophenolate mofetil in allogeneic stem cell transplantation”. Bone Marrow Transplantation 29.1 (2002): 903-906.
  8. K Pathanapitoon., et al. “Clinical manifestations of cytomegalovirus-associated posterior uveitis and panuveitis in patients without human immunodeficiency virus infection”. JAMA Ophthalmology 131.5 (2013): 638-645.
  9. O Shibolet., et al. “Late cytomegalovirus disease following liver transplantation”. Transplantation International 16.11 (2003): 861-865.
  10. T Harper., et al. “Polymerase Chain Reaction Analysis of Aqueous and Vitreous Specimens in the Diagnosis of Posterior Segment Infectious Uveitis”. American Journal Ophthalmology 147.1 (2009): 140-147.                       
  11. MB Mowa., et al. “Inhibition of hepatitis B virus replication by helper dependent adenoviral vectors expressing artificial anti-HBV pri-miRs from a liver-specific promoter”. Biomedical Research International 2014 (2014): 718-743.
  12. VL Morrison., et al. “Results of silicone oil removal in patients with cytomegalovirus retinitis related retinal detachments”. American Journal of Ophthalmology 140.5 (2005): 786-793.
  13. JJ Lee., et al. “Occurrence and reactivation of cytomegalovirus retinitis in systemic lupus erythematosus with normal CD4(+) counts”. Eye 20.5 (2006): 618-621.
  14. J Cukuranovic., et al. “Viral infection in renal transplant recipients”. Scientific World Journal (2012). 
  15. TR Vrabec. “Laser photocoagulation repair of macula-sparing cytomegalovirus-related retinal detachment”. Ophthalmology 104.12 (1997): 2062-2067.
  16. PF McAuliffe and MH Heinemann. “The use of pneumatic retinopexy to delay surgical repair of a retinal detachment associated with the ganciclovir intraocular device”. Ophthalmic Surgery Lasers 29.3 (1998): 244-246.
  17. JE Nasemann., et al. “Early pars plana vitrectomy without buckling procedure in cytomegalovirus retinitis-induced retinal detachment”. Retina 15.2 (1995): 111-116.
  18. A Martidis., et al. “Treating cytomegalovirus retinitis-related retinal detachment by combining silicone oil tamponade and ganciclovir implant”. Ophthalmic Surgery Lasers 33.2 (2002): 135-139.
  19. G Mathur., et al. “Clinical Outcomes of Retinal Detachment Surgery following Cytomegalovirus Retinitis in Patients on Highly Active Anti-retroviral Therapy for Acquired Immune Deficiency Syndrome”. Ocular Immunology Inflammation and Infection 23.5 (2015): 400-404.
  20. VP Dave., et al. “Results of silicone oil removal in post-cytomegalovirus retinitis-related retinal detachment”. Journal Ophthalmic Inflammation and Infection 2.3 (2012): 153-155.
  21. SK Gore., et al. “Cytomegaloviral retinitis-related retinal detachment: outcomes following vitrectomy in the developing world”. International Ophthalmology 34.2 (2014): 205-210.
  22. AP Ciardella., et al. “Cytomegalovirus retinitis and FK 506”. American Journal Ophthalmology 136.2 (2003): 386-389.
  23. LL Sun., et al. “Optical coherence tomography changes in macular CMV retinitis”. Digital Journal Ophthalmology 18.2 (2012): 1-4.
  24. DA Jabs., et al. “Retinal detachments in patients with cytomegalovirus retinitis”. Archives Ophthalmology 109.1 (1991): 794-799.
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Citation

Citation: Adel Alakeely., et al. “R Hegmatogenous Retinal Detachment in Cytomegalovirus Retinitis in A Post Liver Transplant-Immunocompromised Patient: Clinical and Anatomical Features and Visual Outcomes”. Acta Scientific Ophthalmology 3.2 (2020): 16-20.




Metrics

Acceptance rate35%
Acceptance to publication20-30 days
ISI- IF0.782
JCR- IF0.24

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