Ophthalmology Series: Case 4

Paul Chronicles

ANSWERS WILL BE POSTED IN REPLY BOX BELOW 18:00 (CET)

A 32 year old man has recently been tested positive for HIV. He presents to your clinic complaining of reduced vision and floaters. Examination of his retina shows white and hemorrhagic lesions.

Fundoscopy reveals:
Image result for slit lamp CMV retinitis1. What is the most likely diagnosis in this patient ?

2. Describe the findings on fundoscopy

3. How would you confirm the diagnosis ?

4. How would you manage this patient ?

5. What complications may arise if left untreated ?

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One thought on “Ophthalmology Series: Case 4

  1. ANSWERS
    1. CMV Retinitis
    2. Microvascular occlusion causing retinal haemhorrage and cotton wool spots. . Fulminant – hemorrhagic necrosis on white/yellow cloudy retinal lesions. They may be centered around vasculature of what is described as ‘cottage cheese’ appearance.
    3. Polymerase chain reaction (PCR) of the vitreous or aqueous.
    4. The mainstay of treatment is ganciclovir and/or foscarnet given intravenously or into the vitreous. Management also requires HAART. If patients are on HAART, show healed lesion and two reports of CD4 6 months apart of > 100, they can be considered for discontinuation of CMV retinitis therapy. If all fails, opt for surgery which involves intravitreal placement of intraocular ganciclovir devices.
    5. Rhegmatogenous retinal detachments from breaks that occur near thin, necrotic retina if greater than 25% of the retina is involved.

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