CYTOMEGALOVIRUS PAPILLITIS IN PATIENTS WITH ACQUIRED-IMMUNE-DEFICIENCY-SYNDROME - VISUAL PROGNOSIS OF PATIENTS TREATED WITH GANCICLOVIR ANDOR FOSCARNET/

Background: Of ?hose patients with acquired immune deficiency syndrome in whom cytomegaloviral retinitis develops, cytomegaloviral papilliti s reportedly develops in up to 4% as well. Although occasionally patie nts have a good visual outcome, the majority have a poor visual progno sis, with a Visual acuity of 20/200 or worse, even with treatment. Met hods: To evaluate the effects of prolonged induction with foscarnet or ganciclovir on the visual prognosis of cytomegalovirus (CMV) papillit is, the records of 22 patients seen between 1990 and 1995 at the Los A ngeles County-University of Southern California Eye Clinic were review ed, Papillitis was defined as greater than 270 degrees of disc edema/b lurring of the disc margins as seen on direct examination and on color fundus photographs. Results: Eighteen patients with a mean initial vi sual acuity of 20/69 (range, 20/15-20/400) were treated with induction doses of intravenous ganciclovir (range, 57.5 mg/kg twice daily) or f oscarnet (range, 60-90 mg/kg twice or 3 times daily) for a mean of 3.3 weeks. The mean follow-up period was 4.8 months (range, 1-13 months). These patients maintained a mean final visual acuity of 20/68 (range, 20/25-20/400) with greater than 90% resolution of the papillitis. The remaining four patients had poor outcomes (visual acuity < 20/400) be cause of progressive CMV papillitis or retinitis. The median survival time was 4.5 months from the diagnosis of papillitis, but 7 months fro m the onset of CMV ocular infection. Conclusion: Patients with CMV pap illitis have good visual prognosis when managed with high and prolonge d doses of intravenous foscarnet and/or ganciclovir.