Pizza Pie!


CMV Retinitis⁣


Necrotizing full thickness retinitis due to CMV, most common in HIV patients with CD4 count <50⁣

Other causes- leukemia, lymphoma, on immunosuppressants, organ⁣

transplant recipients⁣




Pathogenesis:

CMV reaches the retina hematogenously and infects the vascular endothelium & spreads to retinal cells⁣

Symptoms:

Asymptomatic, photopsia, visual loss, floaters, scotomas⁣

Signs:⁣

AC & vitreous reaction minimal⁣

Irregular border of solitary yellow white active retinitis, small white satellite lesions⁣

Centrifugal spread with central clearing⁣

Prominent vasculitis resulting in ischemia and hemorrhages- Pizza pie/cottage cheese & ketchup appearance⁣

Brushfire pattern of spread along vessels -Frosted branch appearance-⁣

active border advances by 25-300 um/wk⁣

ON involvement- concurrent CNS infection⁣

RRD -1/3 patients when >25% of retina is involved⁣

Types:⁣

Fulminant-hemorrhagic necrosis on white/yellow cloudy retinal lesions, centered around vasculature⁣

Granular-retinal periphery, with minimal necrosis/hemorrhage/vascular sheathing⁣

Perivascular- Frosted branch angitis- white lesions around vessels⁣

Zones:⁣

1- 1DD (1500um) around disc & 2DD (3000um) around fovea:immediately sight threatening ⁣

2- Anterior to zone 1 & posterior to vortex vein ampullae⁣

3- Peripheral to Zone 2⁣

Visual loss:⁣

Macula/ON involvement⁣

Immune recovery uveitis-Rejuvenated immune response against residual viral antigen following immune constitution with HAART⁣

Signs: Vitritis, Optic disc edema, CME, ERM, Cataract, Anterior uveitis etc.⁣

RD⁣

Diagnosis:

Clinical

PCR -aqueous/vitreous⁣

DD: HIV Retinopathy, ARN, Toxo, Syphilis, TB, Behçet’s⁣

CWS: Lesions condense, fade & disappear over 4-6 wks ⁣

CMV Retinitis: Lesions advance, at about 1/2DD in 2-3 wks⁣

Rx:⁣

HAART in AIDS patients ⁣

IV ganciclovir 5-7 mg/kg/day in 2 divided doses for 2 weeks -induction dose⁣

Maintenance dose -OD till complete resolution of lesions & improvement of immune status⁣

Oral valganciclovir 900mg BD as induction dose for 21 days, 900mg OD as maintenance dose⁣

Other options: IV foscarnet/cidofovir, Intraocular ganciclovir device, Intravitreal ganciclovir, Oral leflunomide ⁣


www.ophthalmobytes.com⁣

Image from Rajan Eye Care Hospital⁣


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