The pizza pie or cottage cheese with ketchup appearance 🍕🧀
There are three clinical forms of CMV retinitis. The classical form (pizza pie retinopathy or cottage cheese with ketchup) is characterized by confluent retinal necrosis with hemorrhage that develops mostly in the posterior retina. The advancing edge of these lesions is usually very sharp and spreads contiguously. Typically, over several weeks untreated lesions progress to full-thickness necrosis with resultant retinal gliosis and pigment epithelial atrophy. Patients often have loss of visual field or visual acuity and scotoma. The second type is granular variety of CMV retinitis and the third is frosted branch angiitis variety of CMV retinitis. Treatment of CMV retinitis is individualized and depends upon the location of the active retinitis and the immune status of the patient. Currently available anti-CMV agents include ganciclovir and its prodrug valganciclovir, foscarnet, cidofovir, fomivirsen, ganciclovir implant and oral valganciclovir.