CMV retinitis: the diagnostic challenges and long-term outcomes. The experience of tertiary eye center in Saudi Arabia.

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.