International consensuses and guidelines on diagnosing and managing cytomegalovirus (CMV) retinitis by the Asia-Pacific Vitreo-retina Society (APVRS), the Asia-Pacific Professors of Ophthalmology (AAPPO) and the Asia-Pacific Society of Ocular Inflammation and Infection (APSOII)

Abstract

With the paradigm changes in antiviral therapy, there are a myriad of emerging controversies in the management of cytomegalovirus retinitis (CMVR). A certain extent of variability exists in the management of CMVR among clinical practices worldwide. Hence, alignment in the management strategy is important towards optimizing the care of CMVR. An international panel of experts (IPE) formulated consensus statements for CMVR regarding to its 1) diagnosis, 2) screening, 3) treatment, 4) management in special populations and 5) emerging technologies. The clinical diagnosis of CMVR relies on patient’s susceptibility due to compromised immune function and characteristic fundus manifestations. Polymerase chain reaction (PCR) of intraocular fluid for detection of CMV is indicated when confirmation is necessary. Oral valganciclovir is the preferred first-line treatment, and intravitreal ganciclovir injection when CMVR threatens to involve the posterior pole. Cessation of maintenance treatment can be considered after 6 months when CMVR remains inactive with immune reconstitution. Immune recovery uveitis (IRU) must be distinguished from CMVR relapse. Screening is recommended for high risk cases. Utilization of telemedicine and artificial intelligence-aided interpretation will help to alleviate the resources required for CMVR screening. Evidence for novel antiviral and immunotherapy have been appraised as second-line treatment options.