Cytomegalovirus Infection

  • Systemic infection with cytomegalovirus
  • May cause necrotizing retinitis as virus invades vascular endothelium
  • At risk are immune-compromised patients and infants of HIV/AIDS-infected mothers
  • Systemic and intravitreal antiviral treatment effective if given early
  • Refer immune-compromised patients with visual symptoms, low CD4, high CMV viral loads, or cotton wool spots promptly to ophthalmologist
  • Refer babies whose mothers have HIV/AIDS to ophthalmologist
  • Immune reconstitution with highly active anti-retroviral therapy will be aimed at keeping CD4 count above 100/mm3
  • Direct treatment options include ganciclovir, valganciclovir, foscarnet, cidofovir, and fomivirsen given systemically or intravitreally
  • If started early enough, these treatments arrest infection and preserve vision