Good syndrome and other causes of cytomegalovirus retinitis in HIV-negative patients—case report and comprehensive review of the literature

Downes, Kenneth M.; Tarasewicz, Dariusz; Weisberg, Laurie J.; Cunningham, Emmett T.

doi:10.1186/s12348-016-0070-7

Journal of Ophthalmic Inflammation and Infection

Table 4 Summary of previously reported HIV-negative cases of cytomegalovirus retinitis following intraocular and periocular corticosteroid injection

From: Good syndrome and other causes of cytomegalovirus retinitis in HIV-negative patients—case report and comprehensive review of the literature

Previously published cases	Author (year)	Age (years)	Gender	Unilateral (U) or bilateral (BL)	Indication for corticosteroid	Corticosteroid dose/route	Time from corticosteroid dosing to retinitis (months)	CMV testing	Zone involved^a	Vision when retinitis was first diagnosed	Retinitis treatment^b	Follow-up (months)	Vision at the last Visit
	Saidel et al. (2005) [88]	75	M	U	DME	4 mg IVTA	4.0	CMV retinitis (PCR)	Zone I	20/400	IV ganciclovir, then IV valganciclovir, repeated IVT ganciclovir	6	20/400
	Delyfer et al. (2007) [89] Case 1	77	M	U	CNVM/AMD	20 mg IVTA	4.0	CMV retinitis (serology + PCR)	Zone II	CF at 1.8 m	IVT, IV valganciclovir	6	20/200
	Delyfer et al. (2007) [89] Case 2	69	M	U	CRVO/DME	8 mg IVTA three times over a 3-month interval	3 (after the 3rd IVTA)	CMV retinitis (PCR)	Zone I	20/200	IV ganciclovir and IV valganciclovir	3	20/400
	Furukawa et al. (2007) [90]	54	F	U	DME	10 mg IVTA	4.0	CMV retinitis (serology + PCR)	Zone II	1	IV ganciclovir; IVT foscarnet; vitrectomy and silicone oil tamponade	14	0.5
	Hsu et al. (2007) [91]	77	M	U	DME	4 mg IVTA	1.5	CMV retinitis (PCR)	Zone II	3/200	Valganciclovir	1	20/400
	Ufret-Vincenty et al. (2007) [92]	65	M	U	Uveitic CME/Behcet’s disease	FA implant	53 (after the 1st implant), 5 (after the 2nd implant)	CMV retinitis (“clinical diagnosis”)	Zone II	20/50	IVT foscarnet; ganciclovir implant	5	20/40
	Park et al. (2008) [93]	77	F	U	CRVO/CME due to HTN	4 mg IVTA	4.0	CMV retinitis (PCR)	Zone II	LP	IVT ganciclovir	4	HM
	Sekiryu et al. (2008) [94]	63	M	U	BRVO/DME	4 mg IVTA	7.0	CMV retinitis (PCR)	Zone II	0.1	IV ganciclovir, IV valganciclovir	1	0.6
	Babiuch et al. (2010) [95]	77	M	U	Idiopathic iritis	40 mg PST TA	0.25	CMV retinitis (serology + PCR)	Zone II	20/40	Vitrectomy, endolaser; IVT ganciclovir; ganciclovir implant	NR	NR
	Shah et al. (2010) [96]	62	M	U	BRVO/DME	20 mg IVTA × 2	6.5	CMV retinitis (PCR)	Zone II	20/400	IV valaciclovir; vitrectomy, endolaser and silicone oil; then IV valganciclovir	NR	NR
	Toyokawa et al. (2010) [97]	83	M	U	CNVM/AMD	20 mg PST TA	3.0	CMV retinitis (PCR)	Zone II	0.3	PO valaciclovir, vitrectomy	5	0.1
	Tugal-Tutkun et al. (2010) [98]	30	M	U	Behcet’s panuveitis	IVTA dose NR	3.5	CMV retinitis (serology + PCR)	Zone I, zone II, zone III	20/200	IVT ganciclovir × 2; IV ganciclovir × 5 weeks; azathioprine changed to interferon alpha 2a	8	20/60
	Vertes et al. (2010) [99]	78	F	U	BRVO/CME	4 mg IVTA	3.0	CMV retinitis (serology + PCR)	Zone II	20/40	IV ganciclovir; PO ganciclovir; IVT ganciclovir; then vitrectomy, endolaser	8	20/25
	Zaborowski et al. (2013) [100]	56	F	U	Idiopathic panuveitis/Uveitic CME	4 mg IVTA	6.0	CMV retinitis (PCR)	Zone II	CF	Azathioprine discontinued; intravitreal ganciclovir twice weekly for 3 weeks (2 mg)	2	NR
	Gupta et al. (2013) [32] case 1	70	F	U	DME	IVTA dose NR	4.0	CMV retinitis (PCR)	Zone II	CF	IVT foscarnet; IV valaciclovir; IVT foscarnet × 2; ganciclovir implant	32	CF
	Gupta et al. (2013) [32] case 2	60	M	U	DME	IVTA NR	6.0	CMV retinitis (PCR)	NR	20/400	intravitreal foscarnet; IV valganciclovir; ganciclovir implant	NR	20/300
	Gupta et al. (2013) [32] case 3	84	F	U	BRVO	IVTA NR	6.0	CMV retinitis (PCR)	Zone II	20/150	IVT foscarnet; IV valganciclovir	19	HM
	Takakura et al. (2013) [87] case 1	66	M	U	VKH with steroid-induced cataracts and ocular hypertension, IVTA given during cataract surgery	4 mg IVTA and ASCTA	1.8	CMV retinitis (PCR)	Zone II	20/200	IVT ganciclovir, PO valganciclovir; methotrexate and low-dose oral prednisone	2	20/70
	Takakura et al. (2013) [87] case 2	37	F	U	Bilateral idiopathic posterior uveitis complicated by CME/retinal vasculitis	FA implant	13.0	CMV retinitis (PCR)	Zone I	20/80	IVT foscarnet; PO valganciclovir	2	20/100
	Takakura et al. (2013) [87] case 3	63	M	U	Granulomatous uveitis with CME	40 mg IVTA × 2	3.0	CMV retinitis (PCR)	Zone II	20/60	IV ganciclovir; PO prednisone; PPV	84	20/200
	Takakura et al. (2013) [87] case 4	72	M	U	BRVO	4 mg IVTA	1.3	CMV retinitis (PCR)	Zone II	20/60	IVT ganciclovir	12	CF
Summary	N = 21	Mean, 66.4 years	Male, 14/21 (66.6 %)	21/21 (100 %)	RVO, 7/21 (33.3 %)	1.5–4 mg IVT, 8/21 (38.0 %)	Mean, 4.3 months	Positive aqueous or vitreous PCR, 20/21 (95.2 %)	Zone I, 4/20 reported (20.0 %)	Acuity better than 20/40, 2/21 eyes (9.5 %)	Intravitreal therapy alone, 5/21 (23.8 %)	Mean = 11.8 months	Acuity better than 20/40: 2/21 eyes (9.5 %)
		Median, 69 years	Female, 7/21 (33.3 %)		DME, 8/21 (38.0 %)	8–20 mg, 5/21 (23.8 %)	Median, 4.0 months	Confirmed by other means: 1/21 (4.8 %)	Zone II, 17/20 reported (85.0 %)	Acuity between 20/40 and 20/200, 11/21 eyes (52.3 %)	Systemic therapy alone, 5/21 (23.8 %)	Median = 5.5 months	Acuity between 20/40 and 20/200: 8/21 eyes (38.0 %)
		Range, 30.0–84.0 year	Male to female ratio, 2:1		Uveitic CME, 7/21 (33.3 %)	40 mg, 2/21 (9.0 %)	Range, 0.25–13.0 months		Zone III, 1/20 reported (5.0 %)	Acuity worse than 20/200, 8/21 eyes (38.0 %)	Intravitreal and systemic therapy, 11/21 (52.3 %)	Range = 1–84 months	Acuity worse than 20/200: 11/21 eyes (52.3 %)
					CNVM due to AMD, 2/21 (9.5 %)	FA implant, 2/21 (9.0 %)
					IRU, 0/21 (0.0 %)	Range, 1.5–40 mg

Data used from paper done by Takakura et al (2013) currently in peer review Ocular Immunology and Inflammation
Abbreviations: AMD age-related macular degeneration, BRVO branch retinal vein occlusion, CRVO central retinal vein occlusion, CME cystoid macular edema, CNVM choroidal neovascular membrane, DME diabetic macular edema, ERM epi-retinal membrane, FA fluocinolone acetonide, IRU immune recovery uveitis, IgG immunoglobulin G, CMV cytomegalovirus, NR not reported, PCR polymerase chain reaction, CD cluster designation, NK natural killer, N/A not applicable
^aZone definitions are as follows: zone I defined as macula or optic nerve involvement; zone II defined as mid-periphery; and zone 3 defined as outer periphery. Zone definitions referenced in this paper: Cunningham ET Jr, Hubbard LD, Danis RP, Holland GN. Proportionate topographic areas of retinal zones 1, 2, and 3 for use in describing infectious retinitis. Arch Ophthalmol. 2011;129(11):1507-8 [115]
^bDosing with each modality varied widely across studies

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