Background. Cytomegalovirus (CMV) retinitis is a vision-threatening opportunistic infection that occurs mainly in immunocompromised individuals. Limited data on treatment protocols and management outcomes are available in South Africa (SA). Objectives. To review the clinical presentation, management and outcomes of patients who were diagnosed and treated for CMV retinitis at Groote Schuur Hospital, Cape Town, SA, over a 10-year period, and to compare treatment protocols of 13 public hospitals in SA that treat patients for CMV retinitis. Methods. A retrospective case review was performed of all patients treated for CMV retinitis at Groote Schuur Hospital between 2003 and 2013. In addition, a questionnaire was sent to 13 public hospitals in SA that treat patients with CMV retinitis. Results. A total of 141 eyes in 91 patients were polymerase chain reaction-positive for CMV. Of these patients, 98.6% were HIV-positive and 72.5% were on highly active antiretroviral therapy (HAART) at the time of presentation. Patients who were on HAART at presentation had better mean final visual acuity (VA) than those who were not on HAART (p<0.001). There was a significant association between the number of retinal quadrants involved and final visual outcome (p=0.009). Macular (central vision) involvement had a significant adverse effect on visual outcome compared with cases in which the macula was uninvolved (p=0.005). Conclusions. Independent risk factors that predict final visual outcome include presenting VA, number of retinal quadrants involved, macular involvement and being on HAART at presentation. The diagnosis and management of CMV retinitis differ among treatment centres in SA.

An etiology other than age-related macular degeneration with less hemorrhage superior to the fovea predicts a better outcome in patients with SFH treated with pars plana vitrectomy, subretinal tissue plasminogen activator, and gas tamponade.

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demonstrated factors related to recurrence-free survival or earlier metastasis in certain patients. However, they could not correlate conventional prognostic indicators usually associated with traditional melanomas. This highlights the somewhat unique behaviour of this pathology.Management in our patient was complicated by a number of factors. These included good visual acuity, comfortable patient status, no significant mass effect, no evidence of frank melanoma in the initially biopsied tissue, and the long subclinical history. Löffler and Witschel 3 have described the case of a young patient who managed well initially through biopsies (and suspected debulking through this process) although eventual exenteration was required 7 years later because of severe pain and mass effect. The initial biopsies were separated by a period of 12 months and showed evidence of mitosis, nuclear atypia, and necrosis in the samples. In our patient, low mitotic activity was seen combined with no other concerning features. Silverberg et al. 4 in their description of a giant CBN invading the scalp and brain determined large tumour size, infiltrating margins, atypical nucleoli, and necrosis to be predictive of the aggressive nature of the condition in their patient. Despite the 40-year history of our case, the location of the lesion resulted in eventual compromise of structures located within the confined orbit.This case highlights some of the issues pertaining to management of this rare yet complex clinical entity. Eventual progression to, or subclinical presence of, MM must be considered in all CBN cases. The distinction between CBN and MM is often difficult and requires appreciation of clinical presentation and progression. Early involvement of experienced pathologists and oncology is recommended to ensure appropriate management.