CMV Retinitis Rupesh Agrawal, Carlos Pavesio Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom

History  62, female, black-African  OS: blurred vision and floaters  History of Pneumonia secondary to P.carinii  History of multiple sexual exposure

First Presentation – OS Fundus and FFA  yellowish lesions in the superotemporal quadrant along with retinal hemorrhage.  corresponding findings on FFA of the left eye.  no evidence of retinal vasculitis

First Presentation – OS FLA  quadrantic patch of deep retinitis

First Presentation - Investigations  Blood work up:  chemistry N, haematology N, HIV1 pos, toxo neg, syphilis neg, CD4 <50 cells  AC tap:  CMV positive, culture and gram stain negative

Diagnosis  CMV-retinitis in Left eye with AIDS  based on  clinical findings  positive serology for HIV, low CD4 count and positive CMV titers

Treatment co-managed by Infectious Disease Physician co-managed by Infectious Disease Physician HAART therapy commenced HAART therapy commenced intravitreal foscarnet with oral valganciclovir given intravitreal foscarnet with oral valganciclovir given CD4 count monitored and after the CD4 count were >100 on two consecutive visits and no clinical lesion, oral valganciclovir was given while monitoring renal toxicity CD4 count monitored and after the CD4 count were >100 on two consecutive visits and no clinical lesion, oral valganciclovir was given while monitoring renal toxicity

Final follow up – After 4 months  Ocular lesions resolved  On systemic therapy  for HIV (HAART therapy) and  Oral Trimethoprim-Sulphamethoxazole (960mg BD) prophylaxis for Pneumocystis carinii infection