Implante de ganciclovir de liberación sostenida para el tratamiento de la retinitis por citomegalovirus (CMV) en pacientes con el síndrome de inmunodeficiencia adquirida (SIDA): experiencia inicial en Venezuela / intravitreal ganciclovir sustained release device for the treatment af adquired inmunodeficiency syndrome (AIDS): associated cytomegalovirus (CMV) retinitis in Venezuela

Evaluar la eficacia del implante de ganciclovir de liberación lenta sostenida para el tratamiento de la retinitis por citomegalovirus (CMV) en pacientes con el síndrome de inmunodeficiencia adquirida (SIDA). Diez pacientes (10 ojos) con SIDA y retinitis por CMV asociada fueron incluidos en este estudio. A los ojos con retinitis por CMV activa se les realizo la implantación quirúrgica del deposito ganciclovir. Todos los ojos demostraron resolución de la retinitis por CMV. Ninguno de los ojos demostró progresión. La agudeza visual permaneció sin cambios en tres (30 por ciento) ojos, mejoró en seis (60 por ciento) ojos y disminuyo en uno (10 por ciento) ojos. Complicaciones quirúrgicas incluyeron hemorragia vítrea leve y astigmatismo. Desprendimiento de retina ocurrió en dos (20 por ciento) ojos luego de que la retinitis cicatrizó. El implante de ganciclovir de liberación sostenida ofrece muchas ventajas, comparadas con la terapia intravenosa o la inyección de ganciclovir intravítreo para el manejo de la retinitis por CMV en pacientes con SIDA

Treatment of cytomegalovirus retinitis with an intraocular sustained-release ganciclovir implant

The objective of this prospective study was to evaluate the efficacy and complications of the use of an intraocular sustained-release ganciclovir implant for the treatment of active cytomegalovirus (CMV) retinitis in AIDS patients. Thirty-nine eyes of 26 patients were submitted to ocular surgery. All patients underwent complete ocular examination before and after surgery. The surgical procedure was always done under local anesthesia using the same technique. The mean time for the surgical procedure was 20 min (range, 15 to 30 min). The average follow-up period was 3.7 months. Of all patient, only 4 presented recurrence of retinitis after 8, 8, 9 and 2 months, respectively. Three of them received a successful second implant. All 39 eyes of the 26 patients presented healing of retinitis as shown by clinical improvement evaluated by indirect binocular ophthalmoscopy and retinography. Retinitis healed within a period of 4 to 6 weeks in all patients, with clinical regression signs from the third week on. Six (15.4 percent) eyes developed retinal detachment. None of the patients developed CMV retinitis in the contralateral eye. The intraocular implant proved to be effective in controlling the progression of retinitis for a period of up to 8 months even in patients for whom systemic therapy with either ganciclovir or foscarnet or both had failed. The intraocular sustained-release ganciclovir implant proved to be a safe new procedure for the treatment of CMV retinitis, avoiding the systemic side effects caused by the intravenous medications and improving the quality of life of the patients.