'Creeping' cytomegalovirus retinitis in AIDS.

Abstract

Letters mas, and inflammatory granulomas. Ferry questioned the existence of iris haemangioma. 3 A review of the literature suggests that there are a some well documented cases of both cavernous and capillary haemangioma of the iris. The cavernous haemangioma, or microhaemangioma, which is more common, appears as a venous tuft at the pupillary margin. It can bleed and produce a spontaneous hyphaema.4 Capillary haemangioma has also been reported to occur in the iris. This rare tumour can be associated with a cutaneous capillary haemangioma and it can show spontaneous resolution coincidental with the natural regression of associated cutaneous lesions.5To our knowledge, racemose haemangioma has not been previously reported to affect the iris. The lesion that we report here appears to be entirely compatible with a racemose haemangioma as seen in the retina. advancement,2 and this should not be confused with active infection. Close attention to the border site, serial retinal drawings, and fundus photographs will confirm movement of the border; however, this may be difficult if the retinal vascular landmarks become obliterated or if border activity is absent.We report on two patients with CMVR as the AIDS defining diagnosis who exhibited recurrent infection over a prolonged period characterised by progressive retinal vascular closure and retinal atrophy with very minimal sign of border activity. CASE REPORTSA 39-year-old HIV positive woman complained of blurred vision in her right eye. The ophthalmoscopic appearance of CMVR at the right posterior pole prompted induction intravenous therapy with ganciclovir at 10 mg/kg for 2 weeks. Severe neutropenia interrupted maintenance therapy allowing CMVR progression. Eighteen months later CMVR was diagnosed in the left eye. Despite intravenous foscarnet therapy, progression continued over a 9 month period with little clinical evidence of border activity (Fig 1). She died more than 2 years after diagnosis of CMVR.A 30-year-old HIV positive heterosexual man complained of floaters in the left eye. Ophthalmoscopy revealed foci of CMVR in the right peripheral nasal retina and left inferior hemiretina. Intravenous induction ganciclovir therapy failed to prevent progression; therefore, intravenous induction foscarnet was used. Progressive retinal scarring and enlarging bilateral scotoma were documented over an 18 month period with minimal clinical evidence of border activity (Fig 2). Foscarnet toxicity during the maintenance phase led to periods of subtherapeutic dosing during this Figure 2 Progressive retinal vascular closure in the leftfundus over a 6 month period. Minimal retinal opacification was only observed after creeping disease had been presentfor a further 8 months.The arrowhead indicates the position of a major arteriole for comparison.