CYTOMEGALOVIRUS
Cytomegalovirus (CMV) produces a characteristic necrotizing retinitis in the eyes of immunocomprised adults and infants (Figure 8-16). [
54] CMV retinitis is the most common significant ocular infection in the acquired immunodeficiency syndrome (AIDS). [
55] Initially, it manifests as a perivascular distribution, producing a distinctive granular appearance (Figures 8-17 and 8-18). [
56] Necrotizing infection may lead to retinal detachment. [57][
58]Intraocular washings from attempted surgical repair may contain fragments of infected retina. Cytologic confirmation of CMV infection is frequently quite helpful in management. Characteristic intranuclear and intracytoplasmic inclusions by light microscopy and dense bodies and viral particles by electron microscopy are identified (Figure 8-19).
ACUTE RETINAL NECROSIS SYNDROME
In otherwise healthy adults, a syndrome of acute necrotizing retinitis, vitritis, and vasculitis has been associated with varicella zoster virus [59][
60][
61] and herpes simplex virus (Figure 8-20). [
62][
63][
64][65][
66] Histologic studies illustrate full thickness retinal necrosis, underlying chronic choroiditis, and dense perivasculitis. [67] Retinal detachment may be caused by vitreous traction alone or combined with retinal breaks (rhegmatogenous retinal detachment). [
68]Intraocular washings show severe necrosis and acute inflammation. Fragments of retina are infiltrated by neutrophils with only ghost outlines of their neural fibers. Ground glass intranuclear inclusions may be visible (Figure 8-21).
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Matsuo T, Date S, Tsuji T, Koyama M, Nakayama T, et al. Am J Ophthalmol 1986;101:368-371.65. Reese L, Sheu MM, Lee F, Kaplan JH, Nahmias A. Intraocular antibody production suggest herpes zoster is only one cause of acute retinal necrosis. Invest Ophthalmol Vis Sci 1986;27(Suppl):12.
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