Classification Criteria for Cytomegalovirus Retinitis

Am J Ophthalmol. 2021 Aug:228:245-254. doi: 10.1016/j.ajo.2021.03.051. Epub 2021 May 11.


Purpose: The purpose of this study was to determine classification criteria for cytomegalovirus (CMV) retinitis.

Design: Machine learning of cases with CMV retinitis and 4 other infectious posterior/ panuveitides.

Methods: Cases of infectious posterior/panuveitides were collected in an informatics-designed preliminary database, and a final database was constructed of cases achieving supermajority agreement on diagnosis using formal consensus techniques. Cases were split into a training set and a validation set. Machine learning using multinomial logistic regression was used in the training set to determine a parsimonious set of criteria that minimized the misclassification rate among the infectious posterior/panuveitides. The resulting criteria were evaluated in the validation set.

Results: A total of 803 cases of infectious posterior/panuveitides, including 211 cases of CMV retinitis, were evaluated by machine learning. Key criteria for CMV retinitis included: 1) necrotizing retinitis with indistinct borders due to numerous small satellites; 2) evidence of immune compromise; and either 3) a characteristic clinical appearance, or 4) positive polymerase chain reaction assay results for CMV from an intraocular specimen. Characteristic appearances for CMV retinitis included: 1) wedge-shaped area of retinitis; 2) hemorrhagic retinitis; or 3) granular retinitis. Overall accuracy for infectious posterior/panuveitides was 92.1% in the training set and 93.3% (95% confidence interval: 88.2-96.3) in the validation set. The misclassification rates for CMV retinitis were 6.9% in the training set and 6.3% in the validation set.

Conclusions: The criteria for CMV retinitis had a low misclassification rate and appeared to perform sufficiently well for use in clinical and translational research.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cytomegalovirus / genetics
  • Cytomegalovirus / isolation & purification*
  • Cytomegalovirus Retinitis / classification*
  • Cytomegalovirus Retinitis / virology
  • DNA, Viral / analysis
  • Eye Infections, Viral / classification*
  • Eye Infections, Viral / virology
  • Female
  • Humans
  • Machine Learning*
  • Male
  • Middle Aged


  • DNA, Viral