In immunosuppressed individuals the risk of opportunistic infections is increased when their immune status is poor. The word green means Viridis in latin language, we report a unique case report of HIV female patient with green reflex in the pupillary area in RE, fundus glow is normally red due to reflection of light from the retina, in our case green reflex is probably due to destruction of inner retinal layers. Thick and complete posterior vitreous detachment with normal RCS complex noted in RE on B Scan whereas LE was normal ( Figure 7). On examination LE anterior segment was normal ( Figure 2), pupil was mid dilated, sluggishly reacting to light, fundus examination revealed pale disc, attenuated sclerosed vessels, superficial retinal haemorrhages in the posterior pole with full thickness retinal necrosis in equatorial and peripheral area, sub macular exudation and frosted branch angitis noted in the mid peripheral retina ( Figure 4).įFA of RE showed staining of healed retina in all quadrants ( Figure 5), LE showed hypo corresponding to superficial retinal haemorrhages with mild hyper fluoresecence in the macular area suggestive of macular edema ( Figure 6). On examination RE showed mid dilated and fixed pupil, green reflex noted in pupillary area ( Figure 1), fundus was hazy due to vitritis, optic disc was pale, sclerosed retinal vessels, full thickness active retinal necrosis in the posterior pole with green colour fundus glow in mid and far periphery, heamorhagic necrosis is seen in supero temporal quadrant, enlarged vessel and fibrosed retina in the infero temporal quadrant ( Figure 3). On examination her BCVA in Right eye (RE) was no perception of light, Left (LE) was hand motion. Scan of re showing thick posterior vitreous detachment with retina, choroid sclera, le showing echoe free vitreous cavity with normal RCS complex. Documentation done in every visit, macular changes after intra vitreal injection was documented by taking both horizontal and vertical OCT. Every visit patient was examined in detail, BCVA, anterior segment, fundus and also OCT in left eye to see the central macular thickness. Patient treated with intra vitreal Ganciclovir 500 micro grams, twice weekly with interval of 3days for three weeks, once the activity is decreased, injections were given weekly once, same dose continued for three more weeks and advised to follow every month to observe the fundus changes in left eye. BCVA, slit lamp examination, indirect ophthalmoscopy, FFA, B Scan and documentation done, Right eye was observed to note the further changes in fundus where as Left eye was treated with intra vitreal injection Ganciclovir to preserve the vison. We report a case of middle aged immunocompromised female with cytomegalovirus retinitis presenting with green reflex in pupillary y area of Right eye, her chief complaints were diminished vision in both eyes since one month, she was on HART for 3 years, discontinued for one and half year and again started after the advice of physician, apart from history, systemic and ocular examination done in detailed.
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