Retinal detachment risk in cytomegalovirus retinitis related to the acquired immunodeficiency syndrome

Objectives: To compare the incidence of retinal detachment in patients trea ted with the ganciclovir implant compared with those treated using systemic therapy only, among 511 patients with the acquired immunodeficiency syndro me (RIDS) and cytomegalovirus (CMV) retinitis and to describe the influence of highly active antiretroviral therapy (HAART) on retinal detachment inci dence. Patients and Methods: All patients with AIDS and CMV retinitis at 1 center were followed up prospectively from CMV retinitis diagnosis for incidence o f retinal detachment. Patient- and eye-specific data regarding demographic and clinical characteristics were collected at the time of CMV retinitis di agnosis. Use of anti-CMV and antiretroviral treatments and the development of an immunologic response to HAART during follow-up were recorded. Results: No significant difference in the rate of retinal detachment was fo und between eyes treated with systemic therapy only and those treated with ganciclovir implants, whether used as primary therapy or subsequent to usin g systemic anti-CMV therapy. The use of HAAR? was associated with a 60% red uction in retinal detachment rate (P<.001), with the greatest benefit obser ved among patients who developed an immunologic response to HAART. Conclusions: Our results suggest that there is no substantial excess risk o f retinal detachment when patients with AIDS and CMV retinitis are treated with ganciclovir implants as opposed to systemic anti-CMV therapy only. How ever, the use of HAART in these patients appears to reduce the risk of reti nal detachment substantially.