An HIV patient complains for visual disturbances fundal examination shows bilateral retinal exudates and perivascular hemorrhages. Which of the following viruses are most likely to be responsible for this retinitis :

Ophthalmologic manifestations of HIV infection • The MC abnormal finding on fundus examination are “cotton wool spots”. They represent area of retinal ischemia secondary to microvascular disease. These lesions are not associated with visual loss. • CMV Retinitis : – MC cause of vision loss in AIDS patient. – Usually occurs when CD-4 <50/ μ l. – Usually present as painless progressive of vision, patient may also complain of floaters and scintillations. – The characteristic appearance is that of perivascular hemorrhage and exudate. – It may be complicated by rheumatogenous retinal detachment. – Treatment - oral valganciclovir, IV ganciclovir - DOC • Acute retinal necrosis syndrome = Progressive outer retinal necrosis (PORN) : – Caused by herpes simplex virus, varicella zoster virus. – Associated with pain, keratopathy iritis. – Ophthalmologic examination show widespread pale grey lesions. – DOC is intravenous acyclovir. • Other secondary infections include : – P.carnii - Cause lesion of choroid. – Toxoplasmosis - Cause chorioretinitis.