- 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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