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Cytomegalovirus (CMV) retinitis is one of the most serious ocular manifestations of cytomegaloviral infection, especially common among the immunosuppressed. At Protheragen, we provide full-spectrum diagnostic and therapeutic development services for CMV retinitis. Our team of experts leverages cutting-edge technologies and rigorous scientific methods to advance the field of CMV research.
Cytomegalovirus (CMV) retinitis is a debilitating ocular infection that occurs uniquely in people who are profoundly immunocompromised, such as those suffering from advanced HIV infection or other forms of immunosuppression. It ranks as the most common form of vision impairment in AIDS cases and, if untreated, commonly results in total vision loss permanently. Its features include necrotizing retinitis and hemorrhagic retinopathy, characterized by rapid retinotopic scotoma expansion from the mid-periphery of the eye to the posterior pole. The disease is capable of causing a detached retina, which ultimately results in irreversible vision loss and, as such, this condition requires prompt diagnosis and effective therapeutics.
Fig. 1 Fundus photograph of cytomegalovirus retinitis. (Zhang J., et al., 2024)
Laboratory-Based Diagnostics
The precise detection of CMV retinitis relies heavily on laboratory-based diagnostics. Aqueous humor PCR assays have crystallized as a benchmark for the detection of active CMV infection. These assays can swiftly confirm the detection of CMV DNA, offering a conclusive diagnosis during the early phases of the illness. The use of Real-time quantitative PCR (qPCR) techniques improves the accuracy of the diagnosis through viral load quantification, enabling assessment of the disease state and whether therapeutic is working.
Imaging Diagnostics
The diagnosis and management of CMV retinitis has been modified and managed more accurately with the use of imaging techniques. Subtle changes in the architecture and thickness of the retina such as it's thickening, hyperreflective lesions, and active CMV retinitis disruption of retinal layers, can all be detected using Optical coherence tomography (OCT). Fundus photography, another pertinent imaging modality captures images of the retina with a gunshot like precision, wherein the images retaken can then be analyzed for pathologically necrotic or hemorrhagic retinal changes.
The therapeutic of CMV retinitis is still highly reliant on antiviral therapeutic approaches. Ganciclovir (GCV) is an antiviral medication that is quite common in practice; it prevents the replication of the virus by acting on the DNA polymerase of CMV. Its administration can be through numerous methods, such as intravenous, oral, intravitreal, and even via intraocular implants. GCV has proven to be effective in slowing down the progression of the disease and preserving vision.
Novel immunotherapies are being developed that have the potential to reinstate CMV-specific immunity and improve outcomes. CMV-specific adoptive T-cell therapy entails the transplantation of T cells specific to CMV, which can identify and destroy cells infected with CMV. This technique is effective in restoring protective immunity, especially in recipients of hematopoietic stem cell transplants.
Table 1. Therapeutics for CMV retinitis. (Zhang J., et al., 2024)
| Medication | Administration | Mechanism | Advantages | Limitations |
| Ganciclovir (GCV) | Intravenous Oral Intravitreal Intraocular implant |
CMV DNA polymerase UL54 Inhibitor | Multiple routes of administration Effectively prevents CMV infection and recurrence |
Strong pill burden, including myelosuppressant and liver toxicity |
| Cidofovir (CDV) | Intravenous Intravitreal |
CMV DNA polymerase UL54 Inhibitor | Least expensive Suppresses exacerbations |
Proteinuria, renal failure, neutropenia, and uveitis Ocular hypotony |
| Valganciclovir (VGCV) | Oral | CMV DNA polymerase UL54 | Low pill burden Convenient dosing |
Neutropenia, anemia, and thrombocytopenia |
| Foscarnet (FOS) | Intravenous Intravitreal |
CMV DNA polymerase UL54 Inhibitor (directly) | Combination therapy with Ganciclovir An alternative to Ganciclovir Less bone marrow suppression |
Impaired renal function, anemia, and electrolyte disturbances Vitreous hemorrhage and retinal detachment |
| Maribavir (MBV) | Oral | CMV kinase UL97 inhibitor | No significant renal, hematologic, or hepatic toxicity | Poor penetration into the retina Resistances |
| Letermovir (LET) | Oral Intravenous |
CMV-terminase inhibitor | Well tolerated Combination therapy with Ganciclovir |
Approved only for prophylaxis Reduced efficacy with high viral loads |
| CMV immunoglobulin (CMVIG) | Intravenous | Restore passive CMV-specific T-cell immunity | Restore immunity Well tolerated Combination therapy |
Complex donor selection Costly Infusion reactions |
| CMV-specific adoptive T-cell therapy | Intravenous | Restore CMV-specific T-cell immunity | Restore immunity Well tolerated Alternative option in drug-resistant |
Complex donor selection Costly |
Disclaimer: Protheragen focuses on providing preclinical research services. This table is for information exchange purposes only. This table is not a treatment plan recommendation. For guidance on treatment options, please visit a regular hospital.
Protheragen is leading in the CMV retinitis diagnostics and therapeutics development. The combination of scientific rigor and technical expertise helps us complement the range of services we offer and helps advance therapeutic development in the CMV field.
Protheragen's preclinical research services for CMV retinitis encompass a wide range of activities, from target identification and validation to efficacy and safety assessment of potential therapeutic agents. We utilize state-of-the-art in vitro and in vivo models to simulate the human disease process and evaluate the pharmacodynamics and pharmacokinetics of drug candidates. If you are interested in our services, please feel free to contact us.
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