Asymptomatic cytomegalovirus retinitis after cardiac transplantation.
OBJECTIVE
To determine the prevalence and the risk factors of cytomegalovirus (CMV) retinitis after cardiac transplantation in visually asymptomatic patients.


METHODS
Ophthalmoscopic examinations including fundus fluorescein angiography were performed in asymptomatic patients who had cardiac transplantation at Ege University Hospital between April 1998 and June 2002 to screen for evidence of diagnostic CMV retinitis lesions to determine the prevalence in this population.


RESULTS
Thirteen patients (aged 40 +/- 12.6) who had cardiac transplantation underwent ophthalmoscopic examination 2-50 months (23.5 +/- 16.2 months; mean +/- SD) after transplantation. All recipients had positive serology to CMV before transplantation. During the study period, 3 patients developed asymptomatic CMV reactivation. One patient developed CMV disease (pneumonia). All of the patients were visually asymptomatic during the study period. Two patients (15%) had a history of diabetes mellitus and chronic severe arterial hypertension. Seven recipients (53%) had been heavy cigarette smokers and 3 patients (23%) had hyperlipidemia. Two (15%) of 13 patients with arterial hypertension and diabetes had evidence of asymptomatic active CMV retinitis. These patients were treated with intravenous ganciclovir.


CONCLUSIONS
Active cytomegalovirus retinitis lesions were found in 2 (15%) of 13 cardiac transplantation patients who had no visual symptoms. We think that the patients with systemic microvascular risk factors such as diabetes, hypertension and smoking should be screened closely for the development of CMV retinitis after cardiac transplantation even if the patients have no visual symptoms.
Department of Ophthalmology, Ege University Hospital, Izmir, Turkey. erakgun@med.ege.edu.tr
Tansu
T
Erakgun
Filiz
F
Afrashi
Sanem
S
Nalbantgil
Mustafa
M
Ozbaran
Jale
J
Mentes
D000328:Adult; D017726:Cytomegalovirus Retinitis / Q000209:etiology*; D005260:Female; D005451:Fluorescein Angiography; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D016867:Immunocompromised Host / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009887:Ophthalmoscopy; D015995:Prevalence; D012307:Risk Factors