Factors influencing the treatment duration and visual prognosis of cytomegalovirus retinitis after allogeneic hematopoietic stem cell transplantation

To explore the factors influencing the treatment duration and visual prognosis of cytomegalovirus (CMV) retinitis (CMVR) after allogeneic hematopoietic stem cell transplantation (allo-HSCT).

All participants received ganciclovir intravenous infusion or oral and intravitreal injection of ganciclovir (IVG) 3 mg twice a week for 4 consecutive times (induction phase). The affected eyes were divided into stop treatment group (Group A), continue treatment group (Group B), and relapse after treatment group (Group C) according to whether local therapy could be terminated at the end of the induction phase and whether CMVR recurred within 3mo after the termination of local therapy.

The study included 31 participants (48 eyes) diagnosed with CMVR including 11 males and 20 females. The mean age was (28±8.2)y. There were 17 cases of binocular disease (34 eyes) and 14 cases of monocular disease (14 eyes). Visual acuity improved in 26 eyes (54.1%), remained unchanged in 9 eyes (18.8%), and decreased in 13 eyes (27.1%). The peak value of blood CMV in Group B was significantly higher than that in Group A (P=0.013). The number of eyes with anterior chamber inflammation in Group C was significantly lower than that in Groups A and B (P=0.015, P=0.016). The average number of interval days was higher in Group A than in Group B. For Group A, there was a strong positive correlation between the number of eyes with CMV positive blood (r=0.712, P=0.031) and visual acuity changes. For Group B, there was a moderately strong positive correlation between the days of blood CMV after transplantation (r=0.371, P=0.043) and the times of injections. For Group C, there was a strong positive correlation between the peak value of blood CMV (r=0.719, P=0.029) and the times of injection.

Systemic use of antivirals combined with intravitreal injection of antivirals is effective for patients with CMVR after allo-HSCT surgery. Patients with shorter interval days, higher peak or more days of blood CMV need more injections. Patients with positive blood CMV at initial diagnosis have worse visual prognosis.