Vitreous & Retina






















Infectious / Inflammatory Disorders
Cytomegalovirus retinitis demonstrates characteristic confluent areas of retinal whitening and vascular sheathings along the vascular arcades.
Cytomegalovirus Retinitis

  • Most common ocular opportunistic infection in immunocompromised or immunosuppressed patients, i.e. patients with AIDS or organ transplant recipients
  • In AIDS patients, it usually seen in patients with CD4+ <50 per mm3
  • Clinical features:
    • Symptoms:
      • May be asymptomatic
      • Blurry or cloudy vision, floaters, light flashes, loss of central or peripheral vision
    • Signs:
      • Vitreous cells with mild anterior chamber inflammatory reaction
      • Indolent form: granular patches adjacent to retinal vessels with occasional hemorrhage
      • Fulminant form:
        • Confluent areas of retinal whitening associated with venous sheathing and hemorrhages along the major retinal vascular arcades
      • In both type, the leading edge of the infection will display irregular granular borders with small, isolated satellite lesions
      • Progressive retinal atrophy may complicate the infection
      • Rhegmatogenous retinal detachment may also occur
  • Workup:
    • Complete history and ocular examination
    • Serial fundus photograph to document progression
  • Management:
    • Medical management of the underlying systemic problem
    • Intravenous anti viral agents such as gancyclovir, cidofovir and foscarnet which may be used individually or in combination
    • Alternative intravitreal gancyclovir implant (the effect lasts in 6-10 months)

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