NON-PROFIT ORG. U.S. POSTAGE PAID Permit No. 1529 Salt Lake City, Utah
65 Mario Capecchi Drive, Salt Lake City, Utah 84132
Uveitis Clinical Updates screening protocol for CMV retinitis in bone marrow and solid organ transplant patients.
Repeat DFE every 6-8 weeks while viremic until 6-8 weeks after immune system is reconstituted.4
Exam is repeated immediately if visual complaints occur.
1. With initiation of anti-viral therapy as determined by treatment team. 2. CMV disease defined as any CMV organ disease (lung, gastrointestinal, or central nervous system). 3. Patients who develop CMV viremia or disease prior to transplantation should also be referred for screening. 4. As defined by, and in discussion with transplant team. 5. As age and cognitive status allows. 6. Indications for anterior chamber paracentesis include unclear clinical diagnosis (small or atypical lesions) and need for resistance testing or to rule out co-infection.
C OV ID -19 A N D UVEITIS CARE
Cases of suspected CMV retinitis.
NEW CMV SCREENING PROTOCOL
The timely, systematic ophthalmic examinations were implemented in Fall 2019 to maximize early disease detection and potential interventions to prevent irreversible vision loss in a disease that is largely asymptomatic in early stages. —Katherine Hu, MD
Baseline dilated fundus exam (DFE) with fundus photos within 2 weeks of viremia or disease.
In collaboration with multidisciplinary care teams at Primary Children’s Hospital and University of Utah Health, the Moran Uveitis Division developed a
SCREENING FOR CMV Studies have highlighted a need for a standardized approach to screening for cytomegalovirus (CMV) retinitis in transplant patients, as there are no national ophthalmic screening guidelines for this vulnerable population.
Hematopoietic stem cell and solid organ transplant patients who develop CMV viremia1 or disease.2, 3
Fundus photos including periphery, autofluorescence, fluorescein angiography, visual field testing.5 +/- anterior chamber paracentesis6
There have been no published reports of COVID-19-associated uveitis; however, retinal microvascular changes have been described. Consensus has been evolving as to the optimal management of uveitis patients during the pandemic, especially for those on immunomodulatory therapy (IMT). While there is concern these patients would be at higher risk of severe SARS-CoV-2 infection, literature from multiple subspecialties with large numbers of patients on IMT has not shown this to be the case. Recommendations include continuation of IMT in the absence of known infection, use of local rather than systemic steroids when possible for those at very high risk for severe COVID-19, and a multidisciplinary approach to carefully monitor patients who develop active infection necessitating the discontinuation of IMT. —Marissa B. Larochelle, MD
