57.1 Features
Cytomegalovirus (CMV) retinitis occurs most frequently in patients with severe immunocompromise as a consequence of acquired immunodeficiency syndrome (AIDS) and is the most common ocular opportunistic infection among these patients. It can also occur in patients with other forms of immunosuppression such as iatrogenic immunosuppression following organ transplantation, hematologic malignancies, and diabetes mellitus. It rarely reported to occur in apparently healthy individuals.
57.1.1 Common Symptoms
CMV retinitis may be asymptomatic in up to 50% of cases. Blurred vision, ocular discomfort, scotomata, and floaters may occur. Complaints characteristic of acute uveitis including pain, photophobia, and redness are typically absent in CMV retinitis.
57.1.2 Exam Findings
CMV retinitis typically presents along with mild anterior chamber inflammation that can include keratic precipitates as well as very mild if any vitritis. Three patterns of classic active retinal lesions have been described. Atypical findings such as severe intraocular inflammation, elevated intraocular pressure, retinal arteritis, and acute retinal necrosis-like retinitis may be more common in patients with CMV retinitis without human immunodeficiency virus (HIV).
Necrotizing
Fulminant hemorrhagic retinitis in the background of retinal necrosis (▶ Fig. 57.1).
Fig. 57.1 Fundus photograph of hemorrhagic retinitis involving the optic nerve in a patient with cytomegalovirus retinitis in the setting of human immunodeficiency virus.
Nonnecrotizing
More indolent, granular satellite lesions with little or no hemorrhage. This presentation, in particular, is nearly pathognomonic for CMV retinitis (▶ Fig. 57.2).
Fig. 57.2 Fundus photograph of classic granular, nonhemorrhagic retinitis of the left eye with satellite lesions in a patient with cytomegalovirus retinitis in the setting of immunosuppression.
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