Medical Retina: Case eleven
This 32 year old AIDS patient had this fundal appearance.
a. What is shown in this picture and what is the most likely diagnosis?There is an area of necrotizing retinitis in the left inferior nerve fibre layer. The most likely diagnosis is cytomegalovirus retinitis.b. Which patients with AIDS are at risk of developing this condition?Those with low CD4+ counts are at risk. The typical sufferers have acell count of less than 50 cells per cubic mm.
It is estimated that 40% of AIDS patients will eventually develop CMV retinitis.
c. How would you treat the patient and how long should he receive the treatment?Ganciclovir or foscarnet can be given intravenously or intraocularly. The drugs work by inhibiting the viral DNA polymerase.
Because the drugs are virostatic and not virocidal treatment should be given for life.
d. What is the visual prognosis for this patient?With treatment, the CMV retinitis can be controlled but not eradicated. Visual loss can occur due to involvement of the macula or from retinal detachment. Retinal detachment occurs in 35% of CMV retinitis due to the presence of multiple retinal holes found between the necrotic retina and the normal retina.
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