Management of CMV retinal detachments in the new era of antiretroviral therapy.
In the past, retinal detachment occurred at a rate of 38% after one year of cytomegalovirus retinitis (CMVR). The current rate of detachment may be reduced by improved therapies for CMVR. In addition, the number of new patients acquiring CMVR has fallen, resulting in a lower incidence of these detachments. Another important effect of the new era of antiviral therapy on CMVR-related detachments includes longer patient survival with a need to select surgical strategies that will provide the best long-term visual outcome while still recognizing the unique difficulties posed by detachments in necrotic retinas. Vitrectomy with planned removal of silicone oil, scleral buckle, vitrectomy with gas tamponade, and laser demarcation are strategies that may provide excellent visual and anatomic results for retinal detachments with various characteristics. The final selection of the surgical approach depends on the mechanical factors of the detachment and patient factors such as immune status, expected survival, control of retinitis, and visual needs.