Cytomegalovirus (CMV) Retinitis usually occurs in immunocompromised patients e.g., those suffering from AIDS, on cytotoxic chemotherapy, or long term immuno-suppression following renal transplantation. It occurs only when CD 4 + counts < 50 cells mm3. However, since the advent of Highly Active Antiretroviral Therapy (HAART) there has occured a dramatic reduction in CMV retinitis.
Clinical features
Symptoms. Often asymtomatic, some patients may present with scotoma or decreased vision and/or floaters in one or both eyes.
Anterior Segment signs are ususally absent. Rarely few stellate KPs may be seen.
Posterior Segment signs include:
- Haemorrhagic retinitis characterised by areas of necrosis (yellow white exudates) associated with areas of vasculitis (perivascular sheathing), retinal haemorrhages and loss of fundal details (pizza pie appearance) is a typical presentation in fulminant form of the disease. There occurs progressive retinal atrophy.
- Grannular retinitis characterised by peripheral granular opacities with occasional haemorrhage seen in indolent form of the disease.
- Complications include retinal detachment (up to 30%), retinal atrophy and optic nerve disease.
Treatment
- HAART is recommended to reduce retroviral load and to increase CD4+ count in patients with AIDS .
- Specific anti-CMV treatment includes: valaganciclovir, ganciclovir, foscarnet, and intravenous injections of cidofovir individually or in combination.