Cytomegalovirus (CMV) retinitis is the most common and clinically significant opportunistic ocular infection seen in immunocompromised patients, including those with acquired immune deficiency syndrome (AIDS). With the extensive use of highly active antiretroviral therapy (HAART) in human immunodeficiency virus (HIV)-positive patients, there has been a tremendous decrease in the incidence of CMV retinitis in these patients (23 per 10 000 HIV;AIDS cases in the pre-HAART era to 8 per 10 000 HIV/AIDS cases in the post-HAART era). The presentation of CMV retinitis may be unilateral or bilateral. The onset is insidious, and symptoms may include blurred vision, floaters, visual field defects, or other nonspecific visual complaints. Clinically, the various types of active chorioretinal lesions include (1) hemorrhagic pattern showing confluent area of full-thickness retinal necrosis with a yellow-white granular appearance and associated retinal hemorrhages, which has been referred to as a “pizza-pie” appearance (Figure 14.1); (2) “brush fire” pattern showing rapidly spreading zone of retinal necrosis with yellow-white margin; and (3) granular pattern showing areas of retinal atrophy amid white granular punctate lesions. In all of these, vitreous inflammation is minimal or absent. Visual loss may be profound if the macula or optic nerve (Figure 14.2) is involved. Without treatment, CMV retinitis will become bilateral in 80% of cases and eventually will result in blindness from retinal atrophy, retinal detachment, or optic nerve involvement.
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