Grand Ward Round. Tan Tock Seng Hospital The Eye Institute 05/07/07. History. 66 year old Indian Female Past medical hx: SLE dx 2000 - f/u TTSH RAI. - Had recent IV cyclophosphamide 800mg x 6 doses last 6 months.
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Grand Ward Round
Tan Tock Seng Hospital
The Eye Institute
66 year old Indian Female
Past medical hx:
- f/u TTSH RAI.
- Had recent IV cyclophosphamide 800mg x 6 doses last 6 months.
- Also on oral prednisolone previously on 30 mg bd, reduced to 40 mg om in feb 07 in view of CMV gastritis.
Was seen in eye clinic for on 22/06/07 for follow-up on:
2)SLE not on plaquenil, on steroids
Right eye: 6/12
Left eye: CF 1 feet.
Right eye: PCIOL, cornea clear, AC deep quiet, retrolental vitreal cells ++
Left eye: NS 2+, AC and retrolental quiet
- CMV retinitis
- toxoplasmosis/ TB/ sarcoidosis/ syphilis
Sickle cell retinopathy
Giant cell arteritis
- CD 4 count 22 (25-50)
- CD4/ CD8 Ratio 0.46 (0.50 – 2.50)
Post Barrier Laser treatement
- suggest reduce prednisolone to 15 mg om.
- 2 isolated areas of retinitis in the supero-temporal
- Intravitreal ganciclovir 2mg/0.04ml given BE on
If cost is not an issue…
i)Induction therapy: IV ganciclovir 5mg/kg bd followed by oral valganciclovir 900mg bd (21d) 72 hrs after starting IV therapy.
-> cost $6000 per month!
ii)Following induction, need maintenance therapy to prevent relapse. Dose valganciclovir at 900mg/day.
Clinical Characteristics and Outcomes of Cytomegalovirus
Retinitis in Persons without Human Immunodeficiency
Am J Ophthalmol. 2004 Sep;138(3):338-46
-necrotizing retinitis, often with intraretinal haemorrhage, with either granular or oedematous borders
Rates of visual loss to 20/200 (6/60) 14% per eye-year
- except RD incidence lower