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A 35-year-old male who has commenced anti-retroviral treatment (ART) for HIV presents in the uveitis clinic after complaining of floaters for the last two months. He has a moderate anterior uveitis and moderate to severe vitritis. His visual acuity is 20/100, right eye and 20/30, left eye. He has evidence of old retinal scarring within the right fundus and a fundus photo from 18 months ago is found in his chart as shown above.

1.	The underlying condition in this patient is most likely to be:
	c -- HIV The history suggests an intermediate uveitis, and any of the conditions listed could cause this. However the fundus photograph is of CMV retinitis, and with the history of commencing ART this would suggest that the most likely diagnosis is immune recovery uveitis (IRU). This is ocular inflammation which occurs during ART-induced immune recovery. It mainly occurs in patients with previous CMVR but may arise with other intra-ocular infections such as mycobacterial choroiditis.
2.	Complications of this condition include:
	a -- cataract, retinal neovascularization, and macula oedema IRU is characterized by ocular inflammation following ART initiation and can result in visual loss from macular oedema, retinal neovascularisation and cataract. [Kempen JH, Min YI, Freeman WR, Holland GN, Friedberg DN, Dieterich DT, Jabs DA. Risk of immune recovery uveitis in patients with AIDS and cytomegalovirus retinitis. Ophthalmology. 2006; 113(4):684-94.]
3.	Possible treatment options for this condition (and its complications) would include:
	e -- all of the above All of these modalities have been advocated as a means of treating IRU and its complications.  Intravitreal triamcinolone has been suggested as a way to treat macular oedema [Morrison et al. Ophthalmology 2007;114:334], and orbital floor steroids have been shown to improve vision [Henderson & Mitchell, BJO 1999;83:540]. Oral corticosteroids have been suggested to treat IRU [Holland, Ocul Immunol Inflamm 1999;7:215]. Spontaneous resolution of IRU may occur and so conservative management may be an option, but the long-term complications often require treatment.