title: Clinical features of newly diagnosed cytomegalovirus retinitis in northern Thailand.
abstract: OBJECTIVE
  To characterize the clinical manifestations of cytomegalovirus (CMV) retinitis in northern Thailand.
  
  
  METHODS
  Prospective, observational, cross-sectional study.
  
  
  METHODS
  We recorded characteristics of 52 consecutive patients newly diagnosed with CMV retinitis at a tertiary university-based medical center in northern Thailand. Indirect ophthalmoscopy by experienced ophthalmologists was supplemented with fundus photography to determine the proportion of eyes with various clinical features of CMV retinitis.
  
  
  RESULTS
  Of the 52 patients with CMV retinitis, 55.8% were female. All were HIV-positive. The vast majority (90.4%) had started antiretroviral therapy. CMV retinitis was bilateral in 46.2% of patients. Bilateral visual acuity worse than 20/60 was observed in 23.1% of patients. Of 76 eyes with CMV retinitis, 61.8% had zone I disease and 21.6% had lesions involving the fovea. Lesions larger than 25% of the retinal area were observed in 57.5% of affected eyes. CMV retinitis lesions commonly had marked or severe border opacity (47.4% of eyes). Vitreous haze often was present (46.1% of eyes). Visual impairment was more common in eyes with larger retinitis lesions. Retinitis lesion size, used as a proxy for duration of disease, was associated with fulminant appearance (odds ratio, 1.24; 95% confidence interval, 1.01 to 1.51) and marked or severe border opacity (odds ratio, 1.36; 95% confidence interval, 1.11 to 1.67). Based on lesion size, retinitis preceded antiretroviral treatment in each patient.
  
  
  CONCLUSIONS
  Patients seeking treatment at a tertiary medical center in northern Thailand had advanced CMV retinitis, possibly because of delayed diagnosis. Earlier screening and treatment of CMV retinitis may limit progression of disease and may prevent visual impairment in this population.
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Somsanguan
authors.initials: S
authors.lastname: Ausayakhun
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Keenan
authors.forename: Sakarin
authors.initials: S
authors.lastname: Ausayakhun
authors.forename: Choeng
authors.initials: C
authors.lastname: Jirawison
authors.forename: Claire M
authors.initials: CM
authors.lastname: Khouri
authors.forename: Alison H
authors.initials: AH
authors.lastname: Skalet
authors.forename: David
authors.initials: D
authors.lastname: Heiden
authors.forename: Gary N
authors.initials: GN
authors.lastname: Holland
authors.forename: Todd P
authors.initials: TP
authors.lastname: Margolis
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D017726:Cytomegalovirus Retinitis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D057210:Delayed Diagnosis; D005260:Female; D006679:HIV Seropositivity / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013785:Thailand / Q000453:epidemiology; D014786:Vision Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents