Posterior Uveitis
ICD-10 H30.2 · ICD-11 9B65.Z

Treatment of Posterior Uveitis in Cytomegalovirus Retinitis with AIDS or Post-Transplant Immunosuppression

CMV retinitis is a sight-threatening cause of posterior uveitis that occurs when immune defences are severely compromised — most commonly in patients living with AIDS or in those receiving immunosuppressive therapy after organ transplantation. Early recognition and a structured antiviral approach are essential to prevent progressive retinal damage.

Clinical Scenario

CMV retinitis arises in immunocompromised states such as AIDS or in post-organ-transplant patients on immunosuppressives. It is recognised by a characteristic granular ("pizza pie") appearance and a typical brushfire pattern of spread along retinal blood vessels — features that make prompt identification critical before further retinal territory is lost.

Treatment Goal

Complete resolution of cytomegalovirus retinitis lesions, alongside recovery of immune status.

Approach to Treatment

Management centres on targeted antiviral therapy delivered systemically — either intravenously or orally — with the intravenous route considered the primary choice. When the macula is threatened, intravitreal antiviral delivery is an additional option. Treatment follows a structured induction phase before transitioning to maintenance.

Agent selection, dosing sequence, route decisions, and monitoring milestones are detailed in the full structured protocol below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.4103/0301-4738.58470

  1. CMV retinitis, usually seen in immunocompromised states such as in AIDS or post organ transplant patients on immunosuppressives, has a characteristic granular or pizza pie appearance and a typical brushfire pattern of spread along the blood vessels.
  2. Intravenous ganciclovir-5–7 mg/kg/day in two divided doses for 2 week-induction dose followed by once daily-maintenance dose till complete resolution of lesions and improvement of immune status is the treatment of choice in CMV retinitis.
  3. Intravitreal injections of either ganciclovir or foscarnet may be considered, especially in initial cases where the macula is threatened.
  4. Alternatively, oral valganciclovir-900 mg BD as induction and 900 mg OD as maintenance dose has an additional advantage of being a non-parenteral mode of treatment, avoiding complications related to indwelling catheters, especially in immunocompromised individuals.
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