CMV retinitis is a sight-threatening retinal infection caused by cytomegalovirus, typically in people with severe immunosuppression such as advanced HIV/AIDS or after organ transplantation.
Features
The virus causes necrotising retinitis with areas of whitening, haemorrhage, and vasculitis along retinal vessels.
- Symptoms include blurred vision, floaters, or visual field defects; some patients are initially asymptomatic.
- Without treatment, the infection spreads and can lead to retinal detachment or optic nerve damage.
- Fundus examination shows characteristic “pizza pie” or “cheese and ketchup” appearances.
- Bilateral involvement is common if systemic immunity remains poor.
Treatment
Management combines systemic and sometimes intravitreal antivirals with optimisation of underlying immune status.
- Agents such as ganciclovir, valganciclovir, or foscarnet are used depending on renal function and resistance patterns.
- Regular retinal examinations monitor for treatment response and contralateral involvement.
- Long-term suppressive therapy may be required until immune recovery is stable.
- Prompt recognition and therapy greatly reduce the risk of irreversible visual loss.
