Journal of ophthalmic inflammation and infection · 2026
Occlusive retinal vasculopathy on ultrawide-field fluorescein angiography in intraocular cytomegalovirus infection: a case series.
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Patel Anamika, Testi Ilaria, Petrushkin Harry, Pavesio Carlos
Аннотация
PURPOSE: To describe ultrawide-field fluorescein angiographic features of extensive retinal capillary non-perfusion in eyes with intraocular cytomegalovirus infection.
METHODS: Retrospective, single-centre observational study.
RESULTS: Five patients (six eyes) with intraocular CMV infection were included (mean age 62 years; range 15-84). All eyes showed widespread retinal haemorrhages without features of classical oedematous/haemorrhagic necrotising cytomegalovirus retinitis. In eyes with retinitis, the lesions showed a granular phenotype.Three eyes presented with hypertensive uveitis and raised intraocular pressure without neovascularisation. Ultrawide-field fluorescein angiography demonstrated extensive capillary non-perfusion involving both arterioles and venules, reflecting a predominantly occlusive vasculopathy. Vitreous haemorrhage occurred in three eyes, and one progressed to phthisis bulbi despite virological control. Predisposing factors included haematological malignancy, severe malnutrition, local corticosteroid implantation, diabetes with preceding shingles, and systemic immunomodulatory therapy. All the patients received systemic and intravitreal anti viral treatment and were additionally treated for the raised intraocular pressure and respective complications secondary to retinal ischemia.
CONCLUSION: Intraocular cytomegalovirus infection in non-human-immunodeficiency-virus patients may present as hypertensive uveitis with an occlusive pan-retinal vasculopathy, with or without retinitis, best recognised on ultrawide-field fluorescein angiography. Antiviral therapy and laser may achieve initial control but are insufficient alone; long-term monitoring and patient counselling are essential to address recurrent haemorrhage and neovascular glaucoma.
METHODS: Retrospective, single-centre observational study.
RESULTS: Five patients (six eyes) with intraocular CMV infection were included (mean age 62 years; range 15-84). All eyes showed widespread retinal haemorrhages without features of classical oedematous/haemorrhagic necrotising cytomegalovirus retinitis. In eyes with retinitis, the lesions showed a granular phenotype.Three eyes presented with hypertensive uveitis and raised intraocular pressure without neovascularisation. Ultrawide-field fluorescein angiography demonstrated extensive capillary non-perfusion involving both arterioles and venules, reflecting a predominantly occlusive vasculopathy. Vitreous haemorrhage occurred in three eyes, and one progressed to phthisis bulbi despite virological control. Predisposing factors included haematological malignancy, severe malnutrition, local corticosteroid implantation, diabetes with preceding shingles, and systemic immunomodulatory therapy. All the patients received systemic and intravitreal anti viral treatment and were additionally treated for the raised intraocular pressure and respective complications secondary to retinal ischemia.
CONCLUSION: Intraocular cytomegalovirus infection in non-human-immunodeficiency-virus patients may present as hypertensive uveitis with an occlusive pan-retinal vasculopathy, with or without retinitis, best recognised on ultrawide-field fluorescein angiography. Antiviral therapy and laser may achieve initial control but are insufficient alone; long-term monitoring and patient counselling are essential to address recurrent haemorrhage and neovascular glaucoma.