A FOVEAL-SPARING PATTERN OF CYTOMEGALOVIRUS RETINITIS IN THE ACQUIRED-IMMUNODEFICIENCY-SYNDROME

Purpose: We describe the clinical course of 12 eyes of 10 patients in whom recurrent cytomegalovirus (CMV) retinitis exhibited a foveal-spar ing pattern. Methods: We retrospectively reviewed the case records and photographic charts of 10 patients (12 eyes) with the acquired immuno deficiency syndrome (AIDS), in whom recurrent CMV retinitis exhibited a foveal-sparing pattern within 1600 mm of the foveola. Results: The s ite of primary retinitis was temporal in 10 eyes of nine patients in w hom it was known. The median number of recurrences up to the observati on of foveal-sparing retinitis was two (range one to eight), and five patients had active CMV retinitis despite treatment for al least two c ontinuous months. Once established, the median rate of progression in a non-foveal vector was 2.3 times faster than toward the fovea, and th e median time to reduction in acuity to < 6/30 (or death) was 11 to 14 weeks. Three eyes of three patients retained 6/30 or better acuity up to death. Foveal CMV retinitis ultimately reduced acuity to < 6/30 in five eyes. Six eyes suffered retinal detachment, involving the fovea in five, and being the primary reason for acuity of < 6/30 in four. Fo ur patients suffered dose-limiting toxicity. Conclusion: Foveal-sparin g CMV retinitis arises in patients with recurrent CMV retinitis resist ant to treatment ('clinically resistant'), particularly that which has arisen temporally. Despite its foveolar proximity, and ultimate signi ficant loss of function, the pattern of progression allows for preserv ation of useful foveal vision for longer periods than would have been expected.