Posterior subhyaloid precipitates in cytomegalovirus retinitis
© The Author(s) 2011
Received: 14 June 2011
Accepted: 14 July 2011
Published: 29 July 2011
This study aims to report a novel finding of posterior subhyaloid precipitates (PSPs) in two patients with cytomegalovirus (CMV) retinitis.
A small case series was conducted.
Clinical findings, treatment, and follow-up of two patients with CMV and PSPs are presented.
Inflammatory precipitates may collect in the posterior subhyaloid space in acute CMV retinitis and resolve with treatment.
KeywordsCytomegalovirus retinitis CMV Posterior subhyaloid precipitates Inflammatory precipitates Uveitis AIDS Optical coherence tomography OCT
The AIDS epidemic has provided an opportunity to study the course and clinical features of cytomegalovirus (CMV) retinitis, which is a leading cause of blindness in these immunocompromised patients. The CMV retinitis lesions may develop in all areas of the retina, although the majority of early lesions are adjacent to blood vessels . Secondary rhegmatogenous retinal detachment (RD) often leads to severe vision loss and occurs in 15–40% of eyes at some point during the course of the disease [2, 3]. Mild vitreous and anterior chamber inflammatory reactions are almost invariably present in a patient with active CMV retinitis, but moderate to severe intraocular inflammation is uncommon . We describe two patients in whom a novel finding of posterior subhyaloid precipitates (PSPs) was documented with fundus photography and spectral-domain optical coherence tomography (OCT).
Case presentation 1
Case presentation 2
A 41-year-old healthy white female presented with blurry vision and floaters in the right eye for 4 weeks. She was referred by an outside ophthalmologist for possible acute retinal necrosis and was initiated on valacyclovir hydrochloride (Valtrex) 1 g three times daily. The patient had a history of three episodes of shingles involving her scalp, right torso, and leg. The most recent episode occurred 2 months prior. She also had several episodes of recurrent pneumonia. She denied any prior ocular history.
OCT evaluation of the right eye demonstrated no evidence of fluid in the macula, but demonstrated the presence of PSPs overlying the retina away from the retinitis lesion, along the inferotemporal arcade (Fig. 5b–d).
We present two cases showing a peculiar finding of PSPs occurring in CMV retinitis. Such precipitates have not been previously well documented and reported; therefore, the fundus photos and spectral-domain OCTs presented here are unique in the literature. The OCTs clearly show that these precipitates are located between the posterior hyaloid and the retina and therefore appear to be distinct from vitreous precipitates, which have been previously reported. The curvilinear organization of PSPs in the posterior segment suggest that they descent with gravity and collect along the attachment of the posterior hyaloid to underlying retina. These PSPs cleared during the course of treatment and therefore may potentially be followed as another clinical sign of response to therapy. We can speculate that because the PSPs clear with treatment, they are most likely made up of inflammatory cells. In conclusion, we present a novel finding of posterior subhyaloid precipitates, which were clearly documented by the spectral-domain OCT. We expect that these cases will contribute to the further characterization of the CMV retinitis manifestation in the era of HAART and OCT imaging.
The authors would like to thank Luis A. Bernhard, C.R.A., ophthalmic photographer, Miami Veterans Affairs Medical Center, Miami, FL and Alex Rodriguez, digital photography, ophthalmic photographer, A.V. Technician, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL for their help.
Declaration of interests
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
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