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Cytomegalovirus retinitis (CMVR) in HIV/AIDS:

Cytomegalovirus (CMV) falls under the members of the Herpesviridae family. The disease presents as an opportunistic infection in 75 to 85% of cases; and although infection can occur in healthy individuals, it is uncommon to notice symptomatic CMV infection in those who are not immune suppressed. One of the most deleterious manifestations of Cytomegalovirus (CMV) infection in the eye is CMV retinitis (CMVR).

Cytomegalovirus retinitis (CMVR) is characterized by full-thickness retinal inflammation, hemorrhage, and necrosis. CMVR can cause profound vision loss and may lead to retinal detachment and permanent vision loss. In the absence of known immune suppression, ocular manifestations of CMVR should raise suspicion for HIV infection and are classified as an acquired immunodeficiency syndrome (AIDS) defining illness.

Diagnostic Tools:

The diagnosis of Cytomegalovirus retinitis (CMVR) is primarily clinical and based on the observation of characteristic retinitis on dilated funduscopic examination by a trained ophthalmologist. Polymerase chain reaction (PCR) analysis of aqueous or vitreous ocular fluid can further help confirm the diagnosis and may be effective in cases with atypical clinical presentations.

Management of Cytomegalovirus retinitis (CMVR):

Cytomegalovirus retinitis (CMVR) management involves intravenous (IV), oral, and intravitreal injections (IVI) of antiviral medicines. The location of the Cytomegalovirus retinitis (CMVR) lesions largely dictates the algorithm of treatment. For those with immediate sight-threatening lesions, intravitreal injections in combination with systemic therapy are currently used. For those without immediately sight-threatening lesions, systemic therapy alone with precise observation is reasonable. The main virostatic therapeutic drugs employed today include valganciclovir (oral), foscarnet (IV, IVI), ganciclovir (IV, IVI), and Cidofovir (IV, IVI).

Conclusion:

Cytomegalovirus retinitis (CMVR) is a serious, vision-threatening condition that is primarily responsible for affecting immunosuppressed patients. CMVR is the most common ocular opportunistic infection in HIV-infected patients and is the leading cause of blindness in this population; however, the incidence of Cytomegalovirus retinitis (CMVR) in patients with HIV has dramatically scaled down with antiretroviral (ART) therapy. 

References:

https://eyewiki.aao.org/CMV_Retinitis 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7022607/

https://www.aao.org/eyenet/article/how-to-treat-cytomegalovirus-retinitis

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