Abstract: Objective To observe ultra-wide angle fundus photography and optical coherence tomography (OCT) characteristics in patients with acquired immune deficiency syndrome(AIDS) complicated with cytomegalovirus retinitis (CMVR) at different periods. Design Retrospective case series. Participants 14 patients (22 eyes) diagnosed with AIDS complicated with CMVR from the Affiliated Hospital of Yunnan University and the Third People's Hospital of Kunming from January 2019 to June 2022. Methods The patient's medical records were reviewed. The characteristics of fundus and OCT images at different stages of CMVR, as well as the CD4+T lymphocytes (CD4) and blood CMV-DNA levels at corresponding stages were analyzed. Follow up was for 6~30 months. Main Outcome Measures CD4 value, fundus photography and OCT image features. Results All patients were in the acute stage of CMVR at the time of initial diagnosis, including 2 cases (3 eyes) in the initial stage of CMVR and 12 cases (19 eyes) in the active stage. The mean CD4 value in acute stage was (32.26±25.7)/μL at first diagnosis, and the manifestations of CMVR in initial stage were <1 DD yellow-white granular lesions. OCT showed no thickening of retina but full layer destruction. During the active stage, the fundus showed large yellow and white cheesy exudation accompanied by bleeding, and OCT showed significant thickening of retina at all levels and high reflexes. In 12 cases (19 eyes), there were 9 cases (15 eyes) of interlayer punctuated strong reflexes, 4 cases (6 eyes) of outer layer punctuated strong reflexes, 12 cases (15 eyes) of lesions involved the macular region, and 3 cases (3 eyes) of macular edema. Epiretinal membrane in 12 cases (18 eyes), vitreous inflammatory cells in 11 cases (16 eyes). During follow-up, the mean CD4 in remission period was (380.4±85.2)/μL. Grey and white scars of fundus were in 13 cases (20 eyes). Retinal atrophy and thinning in the lesion area were observed on OCT, and retinal detachment was observed in 1 case (2 eyes). Conclusion The fundus of AIDS patients with CMVR showed different manifestations at different periods, such as yellow and white granular lesions, tomato and cheese lesions, and gray-white cicatricial lesions. OCT showed significant hyperreflective thickening, thinning and atrophy of retina. (Ophthalmol CHN, 2023, 32: 326-331)

Key words:  cytomegalovirus retinitis, acquired immune deficiency syndrome, optical coherence tomography, fundus photography