CMV retinitis

Background

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

Diagnosis

Fundus photograph of CMV retinitis

• 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

Differential Diagnosis

Acute onset flashers and floaters

• Ocular causes
  • Floaters and/or flashes
    • Posterior vitreous detachment
    • Retinal tear or retinal detachment
    • Posterior uveitis
  • Predominantly floaters
    • Vitreous hemorrhage secondary to proliferative retinopathy
    • Sympathetic ophthalmia
  • Predominantly flashes
    • Oculodigital stimulation
    • Rapid eye movements
    • Neovascular age-related macular degeneration
• Non-ocular causes
  • Intraocular foreign body
  • Migraine aura (classic)
  • Migraine aura (acephalgicmigraine)
  • Occipital lobe disorders
  • Postural hypotension

Treatment

Antivirals

Severe Vision Threatening

• Ganciclovir intraocular implant for 8 months AND
  • Valganciclovir 900mg PO q12hrs x 14 days FOLLOWED BY 900mg PO q24hrs x 7 days

Peripheral lesions

• Valganciclovir 900mg PO q12hrs x 21 days FOLLOWED BY 900mg PO q24hrs x 7 days

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

See Also

• HIV - AIDS (Main)
• HIV (Overview)
• CMV esophagitis
• CMV colitis
• CMV pneumonia

Source

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