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Bilateral retinal detachment associated with cytomegalovirus retinitis
Journal français d’ophtalmologie (2017) 40, 811—814
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Bilateral retinal detachment associated with cytomegalovirus retinitis Décollement rétinien bilatéral associé à une rétinite à cytomegalovirus C. Veiga-Tinajero ∗, N. Padrón-Pérez , P. Garcia-Bru , M.J. Rubio-Caso Department of Ophthalmology, Bellvitge University Hospital, Feixa Llarga s/n, l’Hospitalet de Llobregat, 08907 Barcelona, Spain Available online 18 October 2017
Cytomegalovirus (CMV) retinitis affects immunocompromised patients, typically as an opportunistic infection in patients with acquired immune deficiency syndrome (AIDs). Without treatment, retinitis can progress to retinal necrosis and retinal detachment. In these cases, a severe visual impairment can be observed. We report a case of a 46-year-old woman who presented a bilateral, progressive, severe and painless visual loss in both eyes (OU). Best-corrected visual acuity (BCVA) was hand motion (HM) in the right eye (OD) and light perception in left eye (OS). Fundoscopy showed vitritis and diffuse retinitis, yellow-white dense retinal infiltrates, peripheral
∗
Corresponding author. E-mail address: [email protected] (C. Veiga-Tinajero).
http://dx.doi.org/10.1016/j.jfo.2017.01.022 0181-5512/© 2017 Elsevier Masson SAS. All rights reserved.
granular areas and vascular sheathing in OU (Fig. 1). Diffuse retinal necrosis and retinal detachment were also observed (Fig. 2). Blood test results were positive for human immunodeficiency virus (HIV) type 1 and HIV antigen (p24). The HIV viral load was 123.615 copies/mL with a very low CD4 + T cells count (40 cells/mm3 ). IgM and IgG were positive for CMV. We decided to perform a sequential bilateral vitrectomy with silicon oil tamponade in OU. Postoperative examination of OD showed the retina completely attached. Nevertheless, persistent subretinal fluid was observed in OS (Fig. 3). Three months after surgery, BCVA was 0.15 in OD and HM in OS.
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C. Veiga-Tinajero et al.
Figure 1. A and B. Fundus color photographs show vitritis, yellow-white dense retinal infiltrates and vascular sheathing in both eyes (OU). C and D. Peripheral granular areas can be observed in OU.
Bilateral retinal detachment associated with cytomegalovirus retinitis
Figure 2.
A and B. Swept source optical coherence tomography shows retinal detachment at the posterior pole in both eyes.
813
814
C. Veiga-Tinajero et al.
Figure 3. A and B. Fundus color image and swept source optical coherence tomography evidence complete attached retina in the right eye. C and D. Persistent subretinal fluid can be observed in the left eye after surgery.
Disclosure of interest The authors declare that they have no competing interest.
Disponible en ligne sur
ScienceDirect www.sciencedirect.com
IMAGE
Bilateral retinal detachment associated with cytomegalovirus retinitis Décollement rétinien bilatéral associé à une rétinite à cytomegalovirus C. Veiga-Tinajero ∗, N. Padrón-Pérez , P. Garcia-Bru , M.J. Rubio-Caso Department of Ophthalmology, Bellvitge University Hospital, Feixa Llarga s/n, l’Hospitalet de Llobregat, 08907 Barcelona, Spain Available online 18 October 2017
Cytomegalovirus (CMV) retinitis affects immunocompromised patients, typically as an opportunistic infection in patients with acquired immune deficiency syndrome (AIDs). Without treatment, retinitis can progress to retinal necrosis and retinal detachment. In these cases, a severe visual impairment can be observed. We report a case of a 46-year-old woman who presented a bilateral, progressive, severe and painless visual loss in both eyes (OU). Best-corrected visual acuity (BCVA) was hand motion (HM) in the right eye (OD) and light perception in left eye (OS). Fundoscopy showed vitritis and diffuse retinitis, yellow-white dense retinal infiltrates, peripheral
∗
Corresponding author. E-mail address: [email protected] (C. Veiga-Tinajero).
http://dx.doi.org/10.1016/j.jfo.2017.01.022 0181-5512/© 2017 Elsevier Masson SAS. All rights reserved.
granular areas and vascular sheathing in OU (Fig. 1). Diffuse retinal necrosis and retinal detachment were also observed (Fig. 2). Blood test results were positive for human immunodeficiency virus (HIV) type 1 and HIV antigen (p24). The HIV viral load was 123.615 copies/mL with a very low CD4 + T cells count (40 cells/mm3 ). IgM and IgG were positive for CMV. We decided to perform a sequential bilateral vitrectomy with silicon oil tamponade in OU. Postoperative examination of OD showed the retina completely attached. Nevertheless, persistent subretinal fluid was observed in OS (Fig. 3). Three months after surgery, BCVA was 0.15 in OD and HM in OS.
812
C. Veiga-Tinajero et al.
Figure 1. A and B. Fundus color photographs show vitritis, yellow-white dense retinal infiltrates and vascular sheathing in both eyes (OU). C and D. Peripheral granular areas can be observed in OU.
Bilateral retinal detachment associated with cytomegalovirus retinitis
Figure 2.
A and B. Swept source optical coherence tomography shows retinal detachment at the posterior pole in both eyes.
813
814
C. Veiga-Tinajero et al.
Figure 3. A and B. Fundus color image and swept source optical coherence tomography evidence complete attached retina in the right eye. C and D. Persistent subretinal fluid can be observed in the left eye after surgery.
Disclosure of interest The authors declare that they have no competing interest.