HIGH-DOSE (2000-MU-G) INTRAVITREOUS GANCICLOVIR IN THE TREATMENT OF CYTOMEGALOVIRUS RETINITIS

Objective: The authors prospectively studied visual outcome, relapse, complications, and survival of patients with acquired immune deficienc y syndrome (AIDS)-related cytomegalovirus (CMV) treated with high-dose intravitreous ganciclovir (2 mg/0.1 ml) injections. The outcomes were compared with those of patients treated with standard doses of intrav enous ganciclovir in the same institution. The histopathologic and ele ctrophysiologic effects of high-dose intravitreous ganciclovir injecti ons in rabbits also were studied. Design: A nonrandomized case series. Participants: A total of 42 patients (74 eyes) were treated with intr avitreous injections and 18 patients (27 eyes) were treated with intra venous ganciclovir. Five eyes of three New Zealand white rabbits were injected with ganciclovir, and the sixth eye was a control specimen. I ntervention: Patients treated with intravitreous injections received t wice-weekly doses of 2 mg/0.1 ml ganciclovir for 3 weeks, then weekly injections. Patients treated with intravenous ganciclovir received sta ndard doses. Patients were monitored with regular examinations. Rabbit eyes were given intravitreous injections of 1 mg/0.1 ml of ganciclovi r weekly for 4 weeks. Main Outcome Measures: Assessments of vision, re tinal inflammation, and survival were made. Electroretinograms were pe rformed on the rabbit eyes, and they were processed for light and elec tron microscopy. Results: In the intravitreous group, visual acuity (V A) was stable in 64 of 74 eyes, 5 improved, and 5 deteriorated. Sixty- three (85%) of 74 eyes had final VA of 20/20 to 20/40. Relapse occurre d in five eyes (7%; median time, 42 weeks). There were three cases of endophthalmitis. Median survival after diagnosis of CMV retinitis was 36 weeks. In the intravenous group, VA was stable in 18 eyes, 0 improv ed, and 9 deteriorated. Sixteen (59%) of 27 eyes had final VA of 20/20 to 20/40. Relapse occurred in 15 eyes (56%) at a median time of 21 we eks. Median survival was 21 weeks. The rabbit studies showed no eviden ce of toxicity. Conclusion: High-dose intravitreous ganciclovir effect ively suppressed CMV retinitis, preserved vision, and prevented relaps e without deterioration in survival.