Ocular ischemic syndrome initally presenting as CMV retiniti
Published in the Korean Journal of Ophthalmology, the authors present the case of a 71-year-old man with diabetes who presented with a oneweek history of blurred vision in the right eye. The patient had a history of lymphoma, which was in complete remission for 2 years. In the right eye, the patient could count fingers at 50 cm with a relative afferent pupillary defect.

The intraocular pressure was 12 mmHg. Examination of the anterior segment was normal. Fundus examination of the right eye demonstrated 1+ vitreous cells, a whitish edematous retina, retinal hemorrhage with exudate, and narrowing and segmentation of the retinal arteries.

Subsequent fluorescein angiography showed delayed choroidal and arteriolar filling, suggestive of OIS. The patient was observed without additional treatment such as intravitreal steroid injection or panretinal photocoagulation. One month later, the patient complained of worsening visual acuity in the right eye. The right-sided vision included only light perception. The intraocular pressure increased to 30 mmHg. Slit lamp examination demonstrated 3+ cells in the anterior chamber and iris neovascularization.

Fundoscopy revealed dense vitritis with dense retinal whitening in the inferotemporal area, suggestive of infectious retinitis. An anterior chamber paracentesis was performed for polymerase chain reaction. The polymerase chain reaction results were positive for CMV, and negative for varicella-zoster virus, herpes simplex virus, and Epstein-Barr virus.

An intravitreal injection of ganciclovir was administered. The patient was also treated with oral valganciclovir. The retinitis and vitritis improved gradually over the following week; however, the retinal vessels appeared slightly attenuated. Two months later, surgery for neovascular glaucoma was recommended. However, the patient refused further therapeutic interventions given poor visual prognosis and financial concerns.

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