CYTOMEGALOVIRUS RETINITIS - DIAGNOSIS AND STATUS OF SYSTEMIC THERAPY

Cytomegalovirus (CMV) retinitis is a disease of advanced immunosuppres sion that occurs almost exclusively in patients with CD4(+) counts of less than or equal to 50 cells/mm(3). Therefore, this disease usually presents in patients who have already been diagnosed with acquired imm unodeficiency syndrome (AIDS). The rate of progression of untreated CM V retinitis is variable. Typical initial complaints of patients with C MV retinitis may include blurred or decreased vision, loss of peripher al or central vision, and multiple ''floaters.'' The diagnosis of CMV retinitis requires ruling out a number of other ocular disorders that may be confused with CMV retinitis. This review discusses the differen t appearances of CMV retinitis at presentation and the possible retina l responses to therapy for CMV retinitis. An overview of intravenous ( i.v.) ganciclovir or i.v. foscarnet as systemic therapy for treatment of CMV retinitis and their use in combination is also presented. Resul ts indicate that combination therapy with both ganciclovir and foscarn et is more effective in controlling progression of CMV retinitis in re lapsed patients than is monotherapy with either drug. However, combina tion systemic therapy is time-consuming, and this regimen has the grea test negative impact on quality of life. Treatment should involve a co operative effort between the patient's ophthalmologist and the primary AIDS-treating physician. Both must be aware of the location and activ ity of the retinitis and of other medical conditions and concomitant m edications.