Incidence of cytomegalovirus retinitis in patients with human immunodeficiency virus following negative initial screening examination results.

screened for congenital infections, only 1 immunocompetent newborn had active retinitis. Because the disease is considered to be self-limiting and systemic treatment can be harmful, treatment remains controversial. In 2003, the National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group conducted a pharmacokinetic-pharmacodynamic study establishing a safe dose of intravenous ganciclovir in infants with CMV. A subsequent phase 3 randomized controlled study demonstrated the benefit of systemic ganciclovir therapy in reduction of hearing loss in congenital CMV infection with central nervous system involvement. While two-thirds of infants receiving treatment developed neutropenia, no deaths were related to the use of intravenous ganciclovir. Rapid resolution of CMV retinitis in immunocompetent infants has been reported with systemic ganciclovir treatment in 2 isolated cases. In our particular case, optic nerve involvement made complete remission unlikely with intravitreous ganciclovir treatment alone. Nevertheless, treatment temporarily arrested the disease and potentially reduced the degree of tissue damage. The optimal treatment for congenital CMV retinitis remains unknown. Our case and those of others demonstrate that congenital CMV retinitis can persist for months after diagnosis before resolving spontaneously. Early treatment of active cases therefore is recommended to preserve vision. If systemic treatment is delayed or withheld owing to potential toxic effects, intraocular treatment can be used as an adjunctive or alternative treatment to limit retinal and optic nerve damage. The results of our case may therefore assist the management of future cases.