CMV retinitis

Background

• Most frequent and serious ocular OI
• Leading cause of blindness in AIDS pts
• Typically occurs with CD4 less than 50

Diagnosis

• Signs/symptoms are variable; may include:
  • Change in visual acuity
  • Visual field cuts (Scotomas, loss of central vision)
  • Floaters, flashing lights
  • Photophobia
  • Eye redness/pain

Complications

• Retinal detachment
• Complete Vision loss
• CMV Immune Recovery Uveitis (IRU)
  • Patients with retinitis who develop blurry vision after starting HART need ophtho eval to assess for CMV progression, relapse, or IRU
  • Possible cause - T-cell mediated immune reconstitution to latent CMV intraocular antigens
  • Symptoms - Floaters, photophobia, blurred vision
  • Occurs median 20 weeks after starting HART
  • Urgent ophtho eval

Treatment

• Ganciclovir implant and ganciclovir 1–1.5gm PO TID

See Also

• HIV - AIDS (Main)
• HIV (Overview)

Source

Tintinalli

UpToDate - "Pathogenesis, clinical manifestations, and diagnosis of AIDS-related cytomegalovirus retinitis"