CMV retinitis: Difference between revisions
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Acute onset flashers and floaters DDX}} | {{Acute onset flashers and floaters DDX}} | ||
{{HIV associated conditions}} | |||
==Treatment== | ==Treatment== | ||
Revision as of 10:39, 1 August 2015
Background
- Most frequent and serious ocular OI
- Leading cause of blindness in AIDS pts
- Typically occurs with CD4 less than 50
Diagnosis
- Signs/symptoms are variable; may include:
- Change in visual acuity
- Visual field cuts (Scotomas, loss of central vision)
- Floaters, flashing lights
- Photophobia
- Eye redness/pain
Differential Diagnosis
Acute onset flashers and floaters
- Ocular causes
- Floaters and/or flashes
- Posterior vitreous detachment
- Retinal tear or retinal detachment
- Posterior uveitis
- Predominantly floaters
- Vitreous hemorrhage secondary to proliferative retinopathy
- Sympathetic ophthalmia
- Predominantly flashes
- Oculodigital stimulation
- Rapid eye movements
- Neovascular age-related macular degeneration
- Floaters and/or flashes
- Non-ocular causes
- Intraocular foreign body
- Migraine aura (classic)
- Migraine aura (acephalgicmigraine)
- Occipital lobe disorders
- Postural hypotension
HIV associated conditions
- HIV neurologic complications
- HIV pulmonary complications
- Ophthalmologic complications
- Other
- HAART medication side effects[1]
- HAART-induced lactic acidosis
- Neuropyschiatric effects
- Hepatic toxicity
- Renal toxicity
- Steven-Johnson's
- Cytopenias
- GI symptoms
- Endocrine abnormalities
Treatment
Antivirals
Severe Vision Threatening
- Ganciclovir intraocular implant for 8 months AND
- Valganciclovir 900mg PO q12hrs x 14 days FOLLOWED BY 900mg PO q24hrs x 7 days
Peripheral lesions
- Valganciclovir 900mg PO q12hrs x 21 days FOLLOWED BY 900mg PO q24hrs x 7 days
Complications
- Retinal detachment
- Complete Vision loss
- CMV Immune Recovery Uveitis (IRU)
- Patients with retinitis who develop blurry vision after starting HART need ophtho eval to assess for CMV progression, relapse, or IRU
- Possible cause - T-cell mediated immune reconstitution to latent CMV intraocular antigens
- Symptoms - Floaters, photophobia, blurred vision
- Occurs median 20 weeks after starting HART
- Urgent ophtho eval
See Also
Source
- Tintinalli
- UpToDate - "Pathogenesis, clinical manifestations, and diagnosis of AIDS-related cytomegalovirus retinitis"
- ↑ Gutteridge, David L MD, MPH, Egan, Daniel J. MD. The HIV-Infected Adult Patient in The Emergency Department: The Changing Landscape of the Disease. Emergency Medicine Practice: An Evidence-Based Approach to Emergency Medicine. Vol 18, Num 2. Feb 2016.