Cystoid macular edema secondary to immune recovery uveitis in a man with cytomegalovirus retinitis and AIDS

Kathir Yoganathan
HIV/Genito-Urinary Medicine, Abertawe Bro Morgannwg University Health Board, Singleton hospital, Swansea, UK

Abstract: Cytomegalovirus (CMV) is the most common intraocular opportunistic infection in profoundly immunocompromised patients with AIDS. It is characterized by an acute, progressive, necrotizing retinitis in patients with a CD4 count of <50 cells/µL. Although the incidence of CMV retinitis has declined because of the introduction of antiretroviral therapy (ART), a new syndrome of intraocular inflammation has emerged in patients with rising CD4 lymphocyte counts following ART. This is called immune recovery uveitis (IRU). It is thought to occur as a result of restored immunity to various infectious agents, commonly mycobacterial, Cryptococcus, and herpes virus infections. We report a man who was treated for CMV retinitis and later developed IRU in the form of cystoid macular edema (CMO) even though his CMV retinitis remained inactive. His CMO resolved and visual acuity improved 2 years after the onset of CMO without any treatment interventions.

Keywords: HIV, cystoid macular edema, AIDS, CMV retinitis