When hematology meets ophthalmology: Cytomegalovirus retinitis in pediatric stem cell recipients

Table 2 A Summary of the investigations and diagnostic methods for cytomegalovirus retinitis.

Investigation	Findings and utility
Comprehensive ophthalmic examination	Central to diagnosis, identifies characteristic retinal lesions; limited by media opacity (e.g., vitritis)[21]
OCT	Retinal thickening, hyperreflective necrotic lesions (early); retinal thinning, atrophy, photoreceptor, and RPE disruption (late); detects macular involvement[23,24]
FAF	Hypoautofluorescence in necrotic retina; hyperautofluorescent borders indicate active inflammation[25]; ultra-widefield FAF helps assess peripheral involvement[26]
FA	Retinal ischemia, vascular leakage, capillary dropout, telangiectasia; aids in disease monitoring[1]
Serial retinal photography	Tracks disease progression, recurrence, and treatment response; useful in pediatric patients where direct examination is challenging[21]
Visual field testing	Detects scotomas correlating with retinal damage; useful for assessing functional impact of CMV retinitis; requires patient cooperation[1]
PCR for CMV DNA	Highly sensitive and specific for CMV detection in ocular fluids (aqueous/vitreous) and blood; useful in immunocompromised patients[1,27-29]
CMV-specific antibodies	Supportive but less specific in immunosuppressed patients; potential role of tear fluid antibody levels in monitoring disease activity[30]

OCT: Optical coherence tomography; RPE: Retinal pigment epithelium; FAF: Fundus autofluorescence; FA: Fluorescein angiography; PCR: Polymerase chain reaction; CMV: Cytomegalovirus.