Concurrent ocular surface squamous neoplasia with viral reti
The following case series, published in the Indian Journal of Ophthalmology describes simultaneous presentation of ocular surface squamous neoplasia with viral retinitis in HIV-positive patients with low CD4 counts

Case 1
A 36-year-old HIV-positive male, on HAART with CD4 count of 160 cells/mm3, presented with an inferonasal raised opalescent corneal limbal mass (3 × 1 mm) with fimbriated edges in the left eye. Fundus examination in the left eye showed vitritis, multiple retinal haemorrhages and necrotising retinitis clinically suggestive of acute retinal necrosis (viral retnitis).

Serology was positive for syphilis, whereas polymerase chain reaction (PCR) test on aqueous was positive for varicella-zoster virus (VZV). Patient was treated with intravenous acyclovir followed by oral valacyclovir and anti-syphilitic treatment. Excisional biopsy of the ocular surface lesion was performed showing conjunctival epithelial dysplasia.

Case 2

A 41-year-old HIV-positive male, on HAART with CD4 count of 192 cells/mm3, presented with an inferonasal raised gelatinous limbal mass (7 × 5 mm) with prominent feeder vessels. Fundus examination in both eyes revealed mild vitritis, retinal vasculitis and granular retinitis, clinically suggestive of active granular cytomegalovirus retinitis.

PCR test on aqueous was inconclusive. Patient was treated with oral valgancyclovir. Excisional biopsy of the ocular surface lesion was performed showing conjunctival epithelial dysplasia.

Key takeaway:-
Ocular manifestations of HIV may rarely have simultaneous anterior and posterior segment involvement, especially with low CD4 counts. Comprehensive evaluation leading to early diagnosis and management may limit vision-threatening complications.

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