International Review of Ophthalmology ›› 2025, Vol. 49 ›› Issue (6): 401-421.doi: 10. 3760/cma.j.cn115500-20251108-25601

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International consensuses and guidelines on diagnosing and managing cytomegalovirus retinitis

Asia-Pacific Vitreo-retina Society, Asia-Pacific Professors of Ophthalmology, Asia-Pacific Society of Ocular Inflammation and Infection#br# Translating author: Qian Zhuyun1,2, Tao Yong1   

  1. 1 Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China; 2 Beijing GIANTMED Medical Diagnostics Laboratory, Beijing 101300, China
  • Received:2025-11-08 Online:2025-12-22 Published:2025-12-22
  • Contact: Tao Yong, Email：taoyong@mail.ccmu.edu.cn
  • Supported by:
    Beijing Hospitals Authority's Ascent Program (DFL20220301); Beijing Nova Program (20230484445); Excellent Young Talent Innovation Project of Capital Medical Science Innovation Center (CX23YQA02); Ms. May Lam Research and Education Fund of The Primasia International Eye Research Institute (PIERI) of The Chinese University of Hong Kong (Shenzhen); Shun Hing Education and Charity Fund; Bright Future Charitable Foundation Postgraduate Education Fund; Daniel & Co Scholarship

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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.

Key words: Cytomegalovirus retinitis, Controversy, Consensus, Guidelines;Asia-Pacific Vitreo-Retina Society(APVRS), Academy of Asia-Pacific Professors of Ophthalmology(AAPPO);Asia-Pacific Society of Ocular Inflammation and Infection (APSOII)