Retinal arteriolar occlusions due to cytomegalovirus retinitis in elderly patients without HIV

Mean age was 73, 70, and 41 years for immunocompetent, immunocompromised, and HIV-infected patients, respectively. Diabetes and vascular disease were common in the elderly. Vision loss to less than 5/200 occurred in 50% of the immunocompetent elderly patients, and 17% of CMV eyes in immunocompromised and HIV patients. Occlusion of the entire retinal vasculature occurred in 4/7 (57%) of immunocompetent patients despite lack of Zone I involvement, and rubeosis occurred in three, disc neovascularization in one, and vitreous hemorrhage in two patients. Vascular occlusive events were less common in immunocompromised patients and rare in the HIV-infected.CMVR in non-HIV-infected elderly patients is associated with retinal arteriolar occlusions. An intact host immune response may increase damage to retinal vessels. Prompt diagnosis may avert catastrophic vision loss.Cytomegaloviral infection is common. Seroprevalence increases steadily in the USA from 36.3% in 6 to 11-year-olds to 90.8% of those aged 90 or older [1]. The most common ocular manifestation of cytomegalovirus infection is cytomegalovirus retinitis (CMVR), which typically occurs as a resurgent infection in a latently infected host who is severely immunocompromised by HIV infection, chemotherapy, or organ transplantation. CMVR can also rarely present in the elderly or in other minimally compromised individuals as an atypical acute retinal necrosis (ARN) [2-4]. Recognition of cytomegalovirus infection is important as specific anti-CMV treatments rather than the anti-viral agents used for other herpes class viruses are required to control the infection.We present cases of CMVR in 15 elderly, non-HIV-infected adults in order to facilitate clinical recognition and to expand the current literature. Eight of the 19 affected eyes had devastating visual outcomes after delays in diagnosis; in 5 of the 8 eyes, this was due to retinal arteriolar occlusion, a previously under-recognized complication of CMVR. The frequency o