Control of cytomegalovirus retinitis using sustained release of intraocular ganciclovir
R. Anand, S. D. Nightingale, R. H. Fish, T. J. Smith and P. Ashton
Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas.
An experimental intravitreal sustained-release device containing
ganciclovir was used to treat 22 patients with acquired immunodeficiency
syndrome-associated cytomegalovirus retinitis. Fourteen eyes were excluded
(five not involved and nine with macular scarring and/or severe debility).
Thirty eyes received the ganciclovir intraocular device implant and were
prospectively followed up from 16 to 419 days (median, 125 days).
Twenty-seven (90%) of 30 eyes showed stabilization of the retinitis. Nine
(33%) of 27 eyes showed reactivation of the retinitis once the device was
empty of ganciclovir; seven received a replacement device, with subsequent
stabilization of the retinitis. Postoperative complications included
vitreous hemorrhage (n = 1), endophthalmitis (n = 1), and progressive
retinitis (n = 2). Late retinal detachment was seen in three eyes (11%) at
35 to 140 days. Survival analysis of all 30 eyes revealed the mean time to
progression of retinitis to be 19 weeks (133 days). The ganciclovir
intraocular device offers a promising alternative for the treatment of
cytomegalovirus retinitis associated with acquired immunodeficiency
syndrome.
