Cytomegalovirus (CMV) retinitis in AIDS: ganciclovir implant in comparisonto systemic therapy

Introduction: Untreated CMV retinitis with AIDS leads to blindness; therefo re, a life-long virostatic treatment is required. It can either be administ ered systemically or locally, as there are different advantages and disadva ntages. When treating patients we aim at therapy that preserves vision with out diminishing quality of life. it should induce as few drug-induced side effects as possible and not shorten the patient's life expectation. Methods and results: A total of 111 patients (150 eyes) with systemic maint enance treatment were compared retrospectively with 33 patients (62 eyes) t hat received a ganciclovir implant only as maintainance therapy and no addi tional systemic treatment. Patients with an implant showed a prolonged inte rval of nonprogression of retinitis than patients receiving systemic treatm ent. Patients with unilateral retinitis are at higher risk of developing bi lateral disease in the implant group than in the systemically treated group . Manifestation of extraocular disease was equal in both groups. Local trea tment with the implant does nor shorten patient survival time. Conclusion: Local treatment with the ganciclovir implant means quality of l ife for patients and also safe protection of the affected eye. Extraocular disease and survival rime are not influenced adversely by local treatment. However, primarily unilateral involved patients show higher risk for bilate ral disease in the implant group than in the systemically treated group.