Cytomegalovirus Retinitis: Immune Status, Vascular Occlusive Events, and Treatment Outcomes

Purpose: To characterize visual outcomes, treatment requirements, and vascular occlusive events in cytomegalovirus (CMV) retinitis across modern immunosuppressed populations. Methods: A single-center retrospective cohort analysis was performed on 22 eyes of 17 patients with polymerase chain reaction–confirmed CMV retinitis diagnosed between 2014 and 2024. Demographics, immune status, retinitis zone and extent, best-corrected visual acuity (BCVA), vascular occlusive events, treatment modalities, and complications through 12 months were reviewed. Stepwise multivariate regression identified independent predictors of final BCVA and intravitreal (IVT) treatment duration. Results: The mean age was 49 years (range, 33-77); 59% of patients were iatrogenically immunosuppressed, 35% were HIV positive, and 6% were immunocompetent. Zone 1 involvement occurred in 40.9% of eyes, with mean extent of retinitis of 2.9 ± 3.7 clock hours. Retinal vascular occlusions occurred in 8 eyes (36%) and were associated with diabetes mellitus ( P = .024) and older age (trend, P = .059). The median BCVA declined from 0.845 logMAR (20/140) at baseline to 1.345 logMAR (20/440) at 12 months ( P = .029), with 55% losing 2 or more lines. Early BCVA decline (β = 0.95, P = .002) and HIV status (β = 0.86, P = .035) independently predicted worse final vision, while presence of retinal vascular occlusion did not. Longer duration of IVT treatment correlated with late loss of BCVA ( P < .001), whereas a shorter duration correlated with retinal vascular events ( P = .002) and HIV status ( P = .013). Conclusions: CMV retinitis remains highly morbid. Vascular events are seen particularly in older patients with diabetes. Early vision loss and HIV predict poor outcomes. Iatrogenically immunosuppressed patients may require longer durations of IVT therapy.