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
Differential Diagnosis
Template:Acute onset flashers and floaters DDX
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
Source
- Tintinalli
- UpToDate - "Pathogenesis, clinical manifestations, and diagnosis of AIDS-related cytomegalovirus retinitis"