INDICATION, MEDICAL COURSE AND POSTOPERAT IVE COMPLICATIONS AFTER IMPLANTATION OF AN INTRAOCULAR SUSTAINED-RELEASE GANCICLOVIR IMPLANT IN PATIENTS WITH AIDS AND CYTOMEGALOVIRUS RETINITIS

We performed an open clinical trial to assess the safety and efficacy of a 1 mu g/h ganciclovir implant for the treatment of newly and pretr eated cytomegalovirus (CMV) retinitis in patients with the acquired im munodeficiency syndrome (AIDS). Patients and methods: Thirty-two eyes (20 patients) received the ganciclovir intraocular device and were pro spectively followed up from 30 to 365 days. We used a modified techniq ue for fixation of the device in half of the patients. The modificatio n improved the fixation of the implant with a two-hole technique in th e strut. Results: Thirty eyes showed stabilization of the retinitis ov er the time, but in two patients resistance against ganciclovir and ot her nucleosid analogue compounds developed. Postoperative complication s included vitreous hemorrhage (n = 1), cataract (n = 1), and uveitis anterior (n = 1). Late retinal detachment was seen in five eyes (25 %) at 30 to 60 days after implantation. Followup until 1 year after impl antation did not show progression of CMV retinitis in 18 of 20 patient s. All received antiviral CMV therapy to protect noninfected eyes and intestinum against CMV infection. Conclusions: The ganciclovir intraoc ular device seemed to be effective in most cases of CMV retinitis and offers a promising alternative for cytomegalovirus retinitis. Patients pretreated longer than 6 months with i.v. ganciclovir have to be care fully selected for implantation, because resistance against ganciclovi r could be three times more likely than in i.v.-therapy naive patients .