CMV Retinitis in HIV

A 32-year-old man with newly diagnosed HIV (CD4 count 38 cells/μL) presents with floaters and blurred vision in the right eye. Fundoscopy reveals the pattern marked **A** in the diagram—a confluent, dense hemorrhagic retinal necrosis advancing along the vascular arcades with a granular leading edge. The anterior chamber is quiet with minimal inflammation. Which of the following is the most appropriate INITIAL management for this patient?

A 34-year-old man with newly diagnosed HIV presents to the ophthalmology clinic with a 2-week history of floaters and blurred vision in the right eye. His CD4+ count is 28 cells/μL. Dilated fundoscopy reveals the pattern marked **B** in the diagram—areas of yellow-white granular retinal opacification interspersed with patchy intraretinal hemorrhages distributed along the major vascular arcades, advancing at the leading edge. Which of the following is the most appropriate INITIAL management strategy for this sight-threatening lesion?