Cytomegalovirus Retinitis With Rhegmatogenous Retinal Detachment
A patient with history of poorly controlled HIV presented to the emergency room with 1 month of painless, unilateral vision loss in the left eye. Vision on presentation was 20/250 in the left eye with normal intraocular pressure. The right eye was no light perception vision after a remote history of trauma years before. Anterior slit lamp examination of the left eye showed inferior endothelial pigment and 2+ mixed cell and flare in the anterior chamber. Dilated fundus examination showed diffuse hemes and whitening along inferior arcade encroaching into macula, with extensive areas of retinal necrosis and heme temporal to fovea. Macula OCT also showed serous fluid in the macula. An anterior chamber paracentesis was performed, followed by treatment with intravitreal foscarnet and ganciclovir with orders placed for systemic laboratory analysis. Systemic work up showed incompletely treated HIV with CD4 count 254 and low CD4/CD8 ratio of 0.3. Aqueous humor PCR returned positive for Cytomegalovirus DNA. She begun treatment with oral valganciclovir. The patient was subsequently lost to follow up, and when she returned the vision had subjectively worsened and she was found to have a larger collection of subretinal fluid concerning for a rhegmatogenous retinal detachment stemming from areas of atrophic retina. Pars plana vitrectomy with silicone oil fill was performed and the patient completed treatment with valganciclovir and HAART. At her most recent follow up her visual acuity had improved to 20/70 in the left eye.
Presentation Date: 02/20/2025
Issue Date: 04/03/2026
Please log in or click on ENROLL ME to access this course.
