Cytomegalovirus retinitis in diverse immunocompromised populations: clinical presentation, treatment outcomes, and prognostic factors

Background: Cytomegalovirus retinitis (CMVR) is a vision-threatening retinal infection that primarily affects severely immunocompromised individuals. Objectives: This study aimed to compare the clinical presentations, long-term visual outcomes, and predictors of visual prognosis in CMVR patients across different immunodeficiency subtypes. Design: Retrospective cohort study. Methods: This study analyzed 117 eyes from 91 patients with CMVR who were treated at a tertiary eye center between 2009 and 2024. Eyes were stratified by the underlying cause of immunosuppression into a human immunodeficiency virus (HIV)-positive group (71 eyes of 58 patients) and an HIV-negative group (46 eyes of 33 patients). The HIV-negative group included patients with hematologic malignancies, drug-induced immunosuppression (e.g., posttransplant or autoimmune therapy), solid organ transplantation, autoimmune disease, congenital immunodeficiency, and poorly controlled diabetes mellitus type 2 (DM2). Patient demographics and comprehensive ophthalmologic examination findings were recorded and compared across these subgroups. Results: = 0.017) were independent predictors of poorer final visual acuity. Conclusion: CMV retinitis demonstrates distinct clinical phenotypes in different immunosuppressed populations. HIV-negative patients tend to show more pronounced vitritis and vasculopathic retinal features, whereas HIV-positive patients have worse baseline visual acuity. However, the long-term visual prognosis was not significantly influenced by the underlying cause of immunosuppression.