Complications after implantation of intraocular devices in patients with cytomegalovirus retinitis

Purpose: The authors report their surgical experience after sustained-relea se ganciclovir treatment, as well as replacing empty ganciclovir implants i n patients with acquired immune deficiency syndrome (AIDS) and cytomegalovi rus (CMV) retinitis. Methods: Between November 1995 and August 1998, 79 eye s of 49 patients received 99 intravitreal ganciclovir implants. Patients we re examined monthly after implant surgery. Follow-up periods ranged from 6 to 128 weeks. Results: At the first 3-week postoperative visit, 73 eyes (97 .2%) of 46 patients exhibited stable conditions. In 6 eyes (3.8%) of 3 pati ents, further progression was noted due to resistance to ganciclovir. The m ost common early complication (within 6 weeks after implantation) was cysto id macular edema, observed in 7 eyes receiving implants. Retinal detachment was the most common late complication (over 6 weeks after implantation) in 11 eyes. In almost all eyes with CMV retinitis and retinal detachment, inv olvement of more than 25% of the retina was observed. Additional severe com plications included extrusion of the first pellet in 2 eyes and cataract as a late complication in 5 eyes. A total of 28 eyes (35.4%) of 16 patients r eceiving a second implant did not experience significant three-line loss by the end of the follow-up period. Conclusion: In the treatment of CMV retin itis, sustained-release ganciclovir implantation seems to be an alternative to intravenous ganciclovir. Early implantation and additional replacement of the device has the potential to decrease the risk of developing retinal detachment. We would recommend additional systemic antiviral CMV therapy to avoid infection of the fellow eye and CMV disease.