A SENSITIVE AND SPECIFIC POLYMERASE CHAIN REACTION-BASED ASSAY FOR THE DIAGNOSIS OF CYTOMEGALOVIRUS RETINITIS

PURPOSE: To develop a sensitive and specific laboratory assay for the diagnosis of cytomegalovirus retinitis. METHOD: We used a polymerase c hain reaction-based assay for detection of cytomegalovirus DNA in vitr eous samples, We attempted to detect cytomegalovirus DNA in 19 vitreou s samples from patients with the acquired immunodeficiency syndrome (A IDS) who had untreated cytomegalovirus retinitis and in 40 vitreous sa mples from patients with AIDS who had been treated with systemic ganci clovir or foscarnet, or both. We also attempted to detect cytomegalovi rus DNA in vitreous samples from 54 immunocompetent patients, includin g 32 with retinal detachment or macular hole, 11 with vitreous inflamm ation, and 11 with vitreous hemorrhage. Additionally, we attempted to detect cytomegalovirus DNA in 15 vitreous samples from patients with A IDS who had vitreoretinal inflammation not caused by cytomegalovirus. RESULTS: Cytomegalovirus DNA was detected in 18 of 19 eyes with untrea ted cytomegalovirus retinitis. We detected cytomegalovirus DNA in 19 o f 40 vitreous samples from patients with previously treated cytomegalo virus retinitis. Cytomegalovirus DNA was not detected in any of 69 pat ients who did not have a clinical diagnosis of cytomegalovirus retinit is. Thus, the assay had an estimated sensitivity of 95% in detecting u ntreated ed cytomegalovirus retinitis and a sensitivity of 48% in dete cting cytomegalovirus retinitis that had been treated with systemic ga nciclovir or foscarnet, or both. The assay did nor give false-positive results in patients with vitreous hemorrhage or vitreous inflammation . Most important, the assay did not give false-positive results in AID S patients with vitreous inflammation from causes other than cytomegal ovirus retinitis. CONCLUSION: We have developed a sensitive and specif ic diagnostic assay that will assist in the diagnosis of cytomegalovir us retinitis.