CYTOMEGALOVIRUS RETINITIS - DECREASED RISK OF BILATERALITY WITH INCREASED USE OF SYSTEMIC TREATMENT

Cytomegalovirus (CMV) retinitis may be treated systemically or intravi treally. We reviewed retrospectively patients with CMV retinitis, in o rder to determine whether systemic treatment was associated with less spread of CMV retinitis from one eye to the other. Of 222 cases, 92 pa tients had bilateral disease at onset of CMV retinitis, leaving 130 fo r analysis. Bilaterality occurred in 10 patients during 12,687 days of systemic treatment and in 34 during 14,791 days without systemic trea tment (odds ratio [OR] = 2.92; confidence interval [CI], 1.44-5.90). P atients who had received systemic treatment for <50% of the follow-up period had a greater risk of bilaterality (OR = 3.7; CI, 2.79-4.54) th an did the more intensively treated patients. CD4 cell levels also con tributed to increased risk, but multivariate analysis showed that CD4 cell counts and treatment intensity were independent risk factors, CMV retinitis was more likely to become bilateral in patients who receive d less intravenous therapy. Local treatment can complete but does not replace systemically administered therapy.