Ans. is 'a' i.e., CMV retinitis o CMV retinitis is the most common ophthalmic manifestation of CMV, occuring as a congenital infection in infants or an opportunistic infection in the immunocompromised host,o Adults commonly affected include those individuals with acquired immunodeficiency syndrome (AIDS), oncology patients, and patients on immunosuppresive therapy,o There is characteristic hemorrhagic, full thickness retinitis.o In early stage there are yellow-white exudates (areas of retinal necrosis) associated with areas of vasculitis and retinal hemorrhage.o There may be exudative retinal detachment and ultimately, there occurs total retinal atrophy.o There are three distinct variants of CMV retinitisClassical (fulminant) retinitisIt is necrotic retinitisLarge areas of retinal hemorrhage along a whitened, edematous or necrotic retina, usually in posterior pole in the distribution of nerve fiber layer along the vascular arcades.It is also known as "Pizza-Pic retinopathy" or "cottage cheese with catchup".Granular (indolent) retinitisWithout edema, hemorrhage or vascular sheathing, progressing along active border of retinal periphery.Perivascular retinitisFrosted branch angitis with retinal perivasculitis.o Another finding in CMV retinitis is a white granular geographic lesion that clears centrally as it enlarges, leaving a quiet central area of retinal atrophy and mottled pigment epithelium. This has also been described as "brush-fire" pattern.o It should be remembered that vitreous hemorrhage, though, is not common in CMV retinitis, it may occur after initiation of treatment of AIDS (HA ART).o In routine course there is no vireous hemorrhage or vitritis due to immunocompromised state of these patients. But, once the treatment of AIDS is started, their immune status may improve, and capable of producing inflammation. Which may cause vitritis and vitreous hemorrhageIMPORTANT FACTSSalt and Pepper fundusCongenital rubella, Congenital syphilis, Congenital leber amaurosis, Mayous Batten disease, Thioridazine toxicity.o Crumbled chees and ketchup appearance (sauce and cheese appearance)o Pizza pie appearanceo Brush fire appearance CMV retinitis o Satellite lesiono Head light in the fog appearanceToxoplasmosisHemorrhagic retinal necrosisHSV, toxoplasmosis, Bechet's retinitis, CRVO or branch vein occlusionMost common ocular infection in AIDS CMV Most common cause of chorioretinitis in AIDS Bull's eye retinopathy (maculopathy)Chloroquine, Phenothiazine, Bardet-Biedle syndrome, Batten disease, inverse retinitis, pigmentosa, Stargardt disease, Dystrophies, Chronic macular hole.Roth spotsBacterial endocarditis, Puerperal septicemiaSnowball opacities in vitreousPars planitis, Candidiasis, Sarcoidosis, Lyme disease