The following sections briefly describe selected infectious diseases that can cause retinal and choroidal inflammation.
Cytomegalovirus (CMV) retinitis is the most common infectious congenital syndrome worldwide and can result in congenital CMV retinitis (see BCSC Section 6, Pediatric Ophthalmology and Strabismus, Chapter 28 for more in-depth information on this disorder). CMV retinitis is also the most common ocular opportunistic infection in adult patients with advanced AIDS and usually occurs when CD4+ T-cell counts are less than 50/μL. Patients with CMV retinitis typically present with floaters or decreased visual acuity. Clinically, CMV retinitis has a characteristic appearance that consists of opacification of the necrotic retina, typically along retinal vessels and often with areas of hemorrhage. Periphlebitis and even “frosted branch” angiitis may be prominent features. The degree of vitreous inflammation is highly variable. Early CMV retinitis may resemble the cotton-wool spots associated with HIV-related retinopathy. Although the diagnosis is often made clinically, polymerase chain reaction (PCR)–based analysis of ocular fluids may be diagnostic in unclear cases.
CMV retinitis can be treated with ganciclovir or foscarnet, administered systemically or intravitreally. High-dose induction therapy is typically given for 2–3 weeks, after which maintenance therapy is continued until immune reconstitution results in restoration of anti-CMV T-cell immunity—usually at CD4+ T-cell counts greater than 200/μL. Immune recovery uveitis and its complications, most notably CME and epiretinal membrane formation, occurs in approximately 20% of HIV-seropositive patients following immune reconstitution. Up to 50% of eyes with CMV retinitis eventually develop a rhegmatogenous retinal detachment.
CMV retinitis can occur in the absence of HIV infection. This scenario is uncommon, however, and is almost always associated with relative immune suppression, such as that which occurs with use of systemic corticosteroids, noncorticosteroid immunosuppressive agents, or chemotherapeutics.
Lalezary M, Recchia FM, Kim SJ. Treatment of congenital cytomegalovirus retinitis with intravitreal ganciclovir. Arch Ophthalmol. 2012;130(4):525–527.
Takakura A, Tessler HH, Goldstein DA, et al. Viral retinitis following intraocular or periocular corticosteroid administration: a case series and comprehensive review of the literature. Ocul Immunol Inflamm. 2014;22(3):175–182.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.