Poster Anisha Seth

CMV retinitis generally occurs as an opportunistic infection in HIV patients but rarely occurs in other immune-compromised conditions. We describe a patient with NHL with bilateral CMV retinitis, who was treated with intravenous ganciclovir and eventually developed cystoid macular edema (CME) due to IRU. A 52-year-old woman presented with decrease in vision in both eyes for 3 days. Patient was a known case of NHL with chemotherapy completed 1 month back. The total leucocyte count was 1100 cells/mm3 while the CD4+ count was 29 cells/mm3. Best-corrected visual acuity (BCVA) in the right eye was 20/30 and left eye was 5/200. Fundus examination revealed areas of retinal necrosis and haemorrhages in both eyes, suggestive of CMV retinitis, sparing the macula in the right eye and involving the macula in the left eye. Optical coherence tomography of the macula showed normal study in the right eye while macular thinning was seen in the left eye. Patient received intravenous ganciclovir 5mg/kg body weight twice a day for 6 weeks followed by oral valganciclovir once a day with a weekly follow up. At the end of 12 weeks, most of the lesions resolved in both eyes with BCVA improved to 20/20 in the right eye and 20/60 in the left eye. The patient again presented at 15 weeks with decrease in vision in the right eye. On examination, the vision was 20/60 in both eyes, the anterior chamber showed cells and flare and CME was seen in the right eye, which was confirmed on optical coherence tomography and fluorescein angiography. The total leucocyte count (TLC) of the patient was 6500 cells/mm3 while the CD4+ count was 240/mm3 .The patient was started on topical steroids and given posterior subtenon triamcinolone acetonide (PST) 40mg in the right eye along with the maintenance dose of valganciclovir. At 2 weeks, the vision in the right eye improved to 20/20 and the CME resolved without any recurrence of CMV retinitis. Thus, posterior subtenon steroid injection is a safe and effective treatment modality for IRU following CMV retinitis in NHL.