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38 year old male complaining of "seeing spots" OS
Digital Journal of Ophthalmology 1997
Volume 3, Number 22
June 25, 1997
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Daniel Roth, MD | Bascom Palmer Eye Institute, University of Miami, Miami, FL
Differential Diagnosis
Impression: Localized CMV Retinitis OS
The diagnosis of CMV Retinitis in this HIV positive male with a low CD4 count was never in doubt. The question is how best to treat this patient.

Treatment options include:
- Induction with IV Ganciclovir
- Induction with IV Foscarnet
- Intraocular Ganciclovir pellet implant with or without oral Ganciclovir

Treatment Plan
The patient was treated with induction therapy using IV Ganciclovir for 2 weeks BID, followed by maintenance QD. On examination 2 months after treatment began, the patient noted HAVING photopsia for 1 week.

Vision: 20/40 OD, 20/20 OS
Pupils: Equal, reactive, No APD
Motility: Full OU
Applanation pressure: 14 OD, 10 OS
Slit lamp examination: Normal OU Deep/Quiet OU
Fundus examination: See Figures 2a-2b
Impression: Progression of CMV Retinitis OS

How would you treat this patient now?
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Figure 2a
Dilated fundus photograph OS

Figure 2b
Close up OS