Treatment of recurrent cytomegalovirus retinitis with the ganciclovir implant

(PURPOSE)-P-.: To evaluate preoperative characteristics and outcome of the treatment of recurrent cytomegalovirus (CMV) retinitis with the ganciclovir implant. (METHODS)-M-.: Records of 54 patients with acquired immunodeficiency syndro me and active, previously treated CMV retinitis who received a ganciclovir implant in one (n = 31) or both (n = 23) eyes were reviewed. Entry criteria included prior insertion and removal of an indwelling catheter or failure to respond to tolerated doses of ganciclovir and foscarnet, Preoperative fa ctors that might correlate with outcome were analyzed, including demographi c factors, duration of human immunodeficiency virus disease and CMV retinit is, indications for surgery, prior anti-CMV treatment, and extent of retini tis, (RESULTS)-R-.: Forty-six patients completed 1 month of follow-up and were a nalyzed for outcome. Thirty-one (67.4%) had inactive retinitis at 1 month v s 15 (32.6%) with active retinitis, and they received a mean of 23.5 +/- 22 .9 weeks of preoperative ganciclovir vs 58.0 +/- 52.0 weeks in patients wit h active retinitis (P =.003), Involvement of more than 25% of retinal area by CMV retinitis was also correlated with activity at 1 month (P <.001), Pa tients who received implants because of lack of venous access had a median time to progression of 8.0 +/- 3.0 months vs 2.0 +/- 1.2 months fur patient s who had inadequate response or intolerance to intravenous medication (1> = .073), Patients with 6 months or less vs more than 6 months of preoperati ve ganciclovir treatment had progression at a median time of 8.0 + 1.7 mont hs vs 2.0 a 0.3 months, respectively (P =.016). (CONCLUSION)-C-.: Longer duration of preoperative ganciclovir or larger are a of CMV retinitis correlates with lower success of ganciclovir implant the rapy for recurrent retinitis, (C) 1999 by Elsevier Science Inc. All rights reserved.