This 48YO HIV positive male on highly active antiretroviral therapy (HAART) presented with 2 months of vision loss in his left eye. His last CD4 count was 81. Vision was 20/20 OD and counting fingers OS.
Multicolor imaging shows active cytomegalovirus (CMV) retinitis with retinal detachment extending superiorly from the optic nerve into the superotemporal midperiphery. A few atrophic retinal breaks are noted. Fluorescein angiography of his left eye shows variable leakage within the area of retinitis superiorly and severe encircling peripheral ischemia. Vitrectomy with silicone oil was scheduled to repair the detachment in his left eye.
Learning Points:
CMV retinitis develops as a reactivation of latent CMV in immunosuppressed individuals. Before effective antiretroviral treatment emerged in the mid to late 1990’s, CMV retinitis developed in up to 40% of HIV/AIDS patients, often within the last 6 months of life. Treatment includes a combination of intravenous and intravitreal medications, including ganciclovir, foscarnet and cidofovir. Rhegmatogenous retinal detachment is a common late sequela and requires vitrectomy with silicone oil.
