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Risk Factors for Immune Recovery Uveitis in Patients with Cytomegalovirus Retinitis After Hematopoietic Stem Cell
Joo Young Kim1,2, Young Gun Park1,2, Dong-Gun Lee3
1Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Purpose:
To investigate the risk factors and clinical characteristics of immune recovery uveitis (IRU) in patients with cytomegalovirus (CMV) retinitis after hematopoietic stem cell transplantation (HSCT).
Methods:
Clinical variables-including age, sex, type of hematologic disease, survival status, absolute neutrophil count, involved eye, visual acuity, number of intravitreal antiviral injections, recurrence of CMV retinitis, CMV titers in blood and aqueous humor, extent and location of retinal involvement, donor human leukocyte antigen matching, donor relationship, and systemic CMV treatment-were evaluated in patients with CMV retinitis following HSCT.
Results:
The IRU group included 26 eyes from 20 patients, and the non-IRU group included 114 eyes from 79 patients. The IRU group had worse visual acuity than the non-IRU group at both the time of CMV retinitis diagnosis and the final visit (p = 0.036 and p < 0.001). IRU was more likely to develop in eyes with posterior pole involvement, larger retinal lesion areas, and a shorter interval between HSCT and CMV retinitis diagnosis (p = 0.032, p = 0.025, and p = 0.012, respectively). Among patients with IRU, those with extensive retinal involvement, cystoid macular edema, and recurrent IRU had poorer visual outcomes (p = 0.019, p = 0.016, and p = 0.027, respectively).
Conclusion:
Retinal involvement near the posterior pole, larger affected areas, and a shorter interval between HSCT and CMV retinitis diagnosis are significant risk factors for developing IRU in patients with CMV retinitis after HSCT. Careful monitoring for IRU remains essential even after resolution of CMV retinitis.
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