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A 27-year-old male renal transplant recipient acquired cytomegalovirus (CMV) infection of both eyes. This was characterized early by a distinctive necrotic retinitis with discrete advancing edges. A large exudative retinal detachment and hypopyon developed in one eye, and cultures from the anterior chamber aspirate grew CMV. Cytomegalovirus was also isolated from the urine and throat; after serial negative base-line titers, CMV antibody titer became positive. At autopsy CMV was isolated from lung, esophagus, and kidney tissue. Light and electron microscopic studies demonstrated extensive necrosis and disruption of the sensory retina and retinal pigment epithelium with exudative retinal detachments. The diseased retinal cells contained a multiplicity of viral particles in various stages of maturity. Cytomegalic inclusion-bearing cells were demonstrated in the choroid of the more severely affected eye.

Twenty-five patients were examined for ocular complaints following renal transplantation. Besides the expected complications of posterior subcapsular cataract and cytomegalovirus retinitis, other findings-such as focal depigmentation of the retinal pigment epithelium, a lack of hypertensive retinopathy, elevated intraocular tensions, microaneurysms, preretinal wrinkling, serous detachments of the retina, hemorrhages and exudates-were observed.A laboratory clue to the onset of cytomegalovirus retinitis was a rapid rise in cytomegalovirus (CMV) antibody titer and a positive CMV plaque count in tissue culture.

Pathologic material from an acute case of neonatal herpes simplex retinitis is presented. There was marked necrosis of all retinal layers including the pigment epithelium. Choroid and vitreous appeared only secondarily involved. The retinal necrosis was sharply delineated stopping at the ora serrata. We interpret this as being more compatible with an immunologically determined process than with direct infection. Indirect evidence for this viewpoint is the failure to find any evidence of virus in the retina, such as inclusion bodies, by electron microscopy or by fluorescent antibody staining.

The eyes of 39 patients who had received allogenic renal transplants were examined for signs of disease. Nine (23%) had early posterior subcapsular cataracts, two (5%) developed acute cytomegalovirus retinitis, and one developed steroid-induced glaucoma. The lesions which were found were all attributable to the immunosuppressive drug therapy. Thirty-five (87%) had detectable complement-fixing antibodies to cytomegalovirus.