Rarely a patient with HIV infection may develop an ischemic maculopathy. The cause is unknown but may be due to an abnormality of the microvasculature.
Patients present with unexplained vision loss, which may have a sudden onset.
All of the patients have AIDS, with low CD4 lymphocyte counts. The patients described by Cunningham et al were seen prior to availability of HAART.
Most patients have a history of recent or past cytomegalovirus retinitis, with most of the patients receiving anticytomegalovirus therapy.
Fundoscopic changes:
(1) cotton wool spots
(2) opacification of the superficial retina near the fovea (results in a cherry red spot)
(3) intra-retinal hemorrhage near the fovea
Diagnosis is based on changes seen on fluorescein angiography:
(1) enlarged foveal avascular zone
(2) mild staining of the juxtafoveal blood vessels
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