Case 10

Patient Presentation: A 62-year-old female with multiple myeloma was referred for a 3-week history of gradual onset blurry vision, floaters and flashes.  Her past medical history was significant for type II diabetes mellitus, hypertension, dyslipidemia and osteoporosis.  Her medications included cyclophosphamide, metformin, sitagliptin, perindopril, rosuvastatin and alendronate.  Her past ocular history was non-contributory.  On examination, her BCVA was 20/70 OD and 20/60 OS.  There was no RAPD and the IOP was 11 OU. On slit lamp examination, she had nuclear sclerotic changes of the lens bilaterally and 0.5 cells in the AC OU.  She had 1+ vitritis OD and 2+ vitritis OS.

Optos fundus photography was performed and is shown below.

Question: Please describe the main findings.

Question: Which of the following is the correct diagnosis?

An OCT macula of the left eye is performed and shown below:

Question: Describe the findings on the OCT.

Question: Which of the following is an appropriate treatment option for this patient?

Learning Objectives:

1. Recognize features of CMV retinitis that help distinguish it from other necrotizing retinopathies.

2. Recognize key features of active CMV retinitis on OCT.

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