A foveal-sparing pattern of cytomegalovirus retinitis in the acquired immunodeficiency syndrome

Purpose: We describe the clinical course of 12 eyes of 10 patients in whom recurrent cytomegalovirus (CMV) retinitis exhibited a foveal-sparing pattern.
Methods: We retrospectively reviewed the case records and photographic charts of 10 patients (12 eyes) with the acquired immunodeficiency syndrome (AIDS), in whom recurrent CMV retinitis exhibited a foveal-sparing pattern within 1500 mm of the foveola.
Results: The site of primary retinitis was temporal in 10 eyes of nine patients in whom it was known. The median number of recurrences up to the observation of foveal-sparing retinitis was two (range one to eight), and five patients had active CMV retinitis despite treatment for at least two continuous months. Once established, the median rate of progression in a non-foveal vector was 2.3 times faster than toward the fovea, and the median time to reduction in acuity to < 6/30 (or death) was 11 to 14 weeks. Three eyes of three patients retained 6/30 or better acuity up to death. Foveal CMV retinitis ultimately reduced acuity to < 6/30 in five eyes. Six eyes suffered retinal detachment, involving the fovea in five, and being the primary reason for acuity of < 6/30 in four. Four patients suffered dose-limiting toxicity.
Conclusion: Foveal-sparing CMV retinitis arises in patients with recurrent CMV retinitis resistant to treatment ('clinically resistant'), particularly that which has arisen temporally. Despite its foveolar proximity, and ultimate significant loss of function, the pattern of progression allows for preservation of useful foveal vision for longer periods than would have been expected.