Bilateral case of CMV retinitis

The fundus photographs above are of a 43 year old HIV positive male. He was referred by a general ophthalmologist as having a viral retinitis for unknown reasons having denied having HIV infection upon direct inquiry. Upon examination, extensive cytomeglovirus retinitis (CMV retinitis) was found in the right eye, and more isolated CMV retinitis in the left eye. Further questioning led to the patient confirming that he had known HIV infection. He had been HIV positive for 4 years, with a currently unknown T4 count or viral load. The course of action was to start gangiclovir orally and implant a gangiclovir implant into the vitreous cavity of the right eye first, then some weeks later, to the left eye.