Topic outline

  • Grand Rounds

    A patient with a past ocular history of POAG s/p phaco/trab OD and BGI OS, and ERM OS with macular edema OS receiving intravitreal Dexamethasone injections since 2017 presented with left eye redness, decreased VA, and pain for 4 days. He reported no history of trauma, no recent hospitalizations or surgeries, and no HIV, IVDU or systemic immunosuppression. Exam was notable for visual acuity of 20/20 in the right eye and HM in the left eye. Intraocular pressure was 19 and 14. Slit lamp exam was most notable for 2+ cell/flare, sliver hypopyon/settled debris and 1+ vit cell. There was also patchy retinal whitening along the superior and inferior macula along the arcades and in the posterior pole and diffuse midperipheral areas of patchy retinal whitening with scattered hemes, and no visible Dexamethasone. The patient was started on Valganciclovir induction followed by maintenance dosing and injected serially with intravitreal foscarnet and gangiclovir. The patient was injected and followed up a week until quiescent and continued on maintenance Valaciclovir for about 4 months. The patient remains stable 1 year out, with no evidence of reactivation, and has forgone any additional Dexamethasone injections since his episode of retinitis. CMV retinitis is a relatively common entity in HIV/AIDS patients, as well as occasionally in the severely systemically immunocompromised; however, here we point out a case of an otherwise healthy man with a case of CMV retinitis caused by local immunosuppression with Dexamethasone.

    Presentation Date: 08/11/2022
    Issue Date: 08/19/2022