The high-dose, alternate-week intravitreal ganciclovir injections for cytomegalovirus retinitis in acquired immune deficiency syndrome patients on highly active antiretroviral therapy.

ABSTRACT

OBJECTIVES: To evaluate the efficacy, and complications of the high-dose, alternate-week, intravitreal ganciclovir injection for cytomegaloviral retinitis (CMVR) in acquired immune deficiency syndrome (AIDS) patients on highly active antiretroviral therapy (HAART). DESIGN: Retrospective case series. PARTICIPANTS: AIDS patients with CMVR and on HAART MATERIAL AND METHOD: The high-dose, 4 mg/0.1 ml, ganciclovir was injected intravitreally to the enrolled patients on an alternate-week basis. The patients were monitored clinically until the retinitis was inactive, then the injections were withdrawn. The injections were re-initiated if relapse occurred. MAIN OUTCOME MEASURES: The number of eyes achieved inactive retinitis and corresponded to the number of injections, number of relapses and corresponded duration, visual acuity during the injection, and complications of the injection. RESULTS: Inactive lesions were found in 42/51 eyes (82.40%), the corresponding mean number of injections was 5.4 (1-18) per eye. There was no relapse and the corresponded duration of follow-up was 5.1 months (1-16). The final visual outcomes were improved or stable in 26 eyes (50.9%). These visual outcomes were statistically related to initial visual acuity (p = 0.022) but not statistically related to the number of injections (p = 0.929). Complications were found in 7/51 eyes (13.7%). They were vitreous haze, immune recovery uveitis, rhegmatogenous retinal detachment, and infectious endophthalmitis. CONCLUSION: The high-dose, alternate-week, intravitreal injection of ganciclovir may be an alternative for the treatment of CMVR in AIDS patients who are on HAART However, the induction course is longer than the weekly regimen and close monitoring of patients is essential.