Ganciclovir implant exchange. Timing, surgical procedure, and complications
D. F. Martin, F. L. Ferris, D. J. Parks, R. C. Walton, S. D. Mellow, D. Gibbs, N. A. Remaley, P. Ashton, M. D. Davis, C. C. Chan and R. B. Nussenblatt
Department of Ophthalmology, Emory University School of Medicine, Atlanta, Ga., USA.
BACKGROUND: The ganciclovir implant is effective for the treatment of
cytomegalovirus (CMV) retinitis. The device eventually runs out of drug,
however, and must be replaced. We report our experience with exchanging
ganciclovir implants during the course of a randomized clinical trial.
METHODS: During our study, patients with newly diagnosed peripheral CMV
retinitis were treated with a ganciclovir implant. The implant was
scheduled for exchange at 32 weeks. It was exchanged earlier if progression
of CMV retinitis occurred. Patient examinations and standard fundus
photography were performed at 2-week intervals after the exchange
procedure. RESULTS: Twenty-six exchange procedures were performed.
Twenty-two eyes in 15 patients received a second implant and 4 eyes in 4
patients later received a third implant. Cytomegalovirus retinitis was
rendered or maintained inactive in 22 of 23 cases with more than 1 month of
follow-up after the second or third implants. Complications after the
second implant procedure included transient vitreous hemorrhage in 5 eyes,
postoperative inflammation in 1 eye, and retinal detachment in 1 eye.
Median visual acuity returned to 20/25 by 28 days and to 20/20 by 42 days.
Complications after the third implant procedure included dense vitreous
hemorrhage in 3 of 4 eyes. Median survival time after a second implant
procedure was 89 days. CONCLUSIONS: The initial ganciclovir implant
exchange procedure is well tolerated with continued long-term control of
CMV retinitis. Multiple reentries through the same wound may be associated
with an increased risk for vitreous hemorrhage.
