CMV Retinitis Progression

These fundus montage photographs depict the situation of a patient first seen in 2014 with complaints of dark oval spots and a constant film that was blurring his vision in the right eye. He had HIV infection with a T4 count less than 50 and had been diagnosed four years earlier. Upon examination, his vision was 20/50 in the right and 20/16 in the left. In his right eye, he had an afferent pupillary defect. His confrontation visual field showed a defect in the superior nasal quadrant. Confrontation visual field testing for his left eye was normal. Retinal examination revealed extensive cytomegalovirus retinitis in the mid-periphery of his right eye and milder involvement of the left eye. Note the retinitis in both eyes on his first eye exam 5-2-2014 (yellow arrows). He underwent serial intravitreal ganciclovir injections in both eyes over a course of six months and took oral valganciclovir for part of the time until bone marrow suppression occurred. The retinitis appeared inactive in the right eye on date 10-14-2014 (blue arrow); however his left eye had new activity in the superior nasal quadrant (white arrow). In early 2015, he was treated with intravitreal Foscarnet injections. On both 3-3-2016 and 1-12-2017, the fundus montage images show a large pigmented chorioretinal scar in his right eye and mild scarring in his left (green arrows). His vision was now at 20/40 in both eyes with inactive CMV. His T4 count gradually increased to over 150 and intravitreal injections were tapered and then discontinued.