TREATMENT OF CLINICALLY RESISTANT CYTOMEGALOVIRUS RETINITIS WITH COMBINED INTRAVITREAL INJECTIONS OF GANCICLOVIR AND FOSCARNET

PURPOSE: To determine the efficacy of combined ganciclovir and foscarn et intravitreal injections in controlling clinically resistant cytomeg alovirus retinitis in a 37-year-old man with the acquired immunodefici ency syndrome who refused systemic therapy. METHODS: The patient refus ed systemic therapy and was treated with intravitreal injections of ga nciclovir and foscarnet, which were then combined when the retinitis b ecame resistant to either drug alone. RESULTS: The retinitis was initi ally controlled with bilateral intravitreal ganciclovir injections. Af ter reactivation of retinitis in the left eye, intravitreal foscarnet was effective until recurrent retinitis threatened the center of the f ovea. The retinitis continued to progress until combined intravitreal injections of ganciclovir and foscarnet were administered. CONCLUSIONS : Combined intravitreal injections of ganciclovir and foscarnet may be effective in treating cytomegalovirus retinitis when the infection is clinically resistant to either intravitreal drug alone. Intravitreal injections can be effective in controlling cytomegalovirus retinitis i n patients who are intolerant of or refuse systemic therapy.