Vitreous and Retina

Cytomegalovirus Retinitis

Cytomegalovirus retinitis demonstrates characteristic confluent areas of retinal whitening and vascular sheathings along the vascular arcades.
  • Most common ocular opportunistic infection in immunocompromised or immunosuppressed patients, i.e. patients with AIDS or organ transplant recipients
  • In AIDS patients, it usually seen in patients with CD4+ <50 per mm3

Clinical Features

  • Symptoms:
    • May be asymptomatic
    • Blurry or cloudy vision, floaters, light flashes, loss of central or peripheral vision
  • Signs:
    • Vitreous cells with mild anterior chamber inflammatory reaction
    • Indolent form: granular patches adjacent to retinal vessels with occasional hemorrhage
    • Fulminant form:
      • Confluent areas of retinal whitening associated with venous sheathing and hemorrhages along the major retinal vascular arcades
    • In both type, the leading edge of the infection will display irregular granular borders with small, isolated satellite lesions
    • Progressive retinal atrophy may complicate the infection
    • Rhegmatogenous retinal detachment may also occur

Workup

  • Complete history and ocular examination
  • Serial fundus photograph to document progression

Management

  • Medical management of the underlying systemic problem
  • Intravenous anti viral agents such as gancyclovir, cidofovir and foscarnet which may be used individually or in combination
  • Alternative intravitreal gancyclovir implant (the effect lasts in 6-10 months)