Treatment of Cytomegalovirus Retinitis in AIDS Patients with Intravitreal Ganciclovir
Somsanguan Ausayakhun MD, MHSc*, Prapa Yuvaves MD*, Suphop Ngamtiphakorn PN*, Jeradech Prasitsilp PN*
Affiliation : * Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai
Background : Cytomegalovirus (CMV) retinitis is the most common opportunistic ocular infection in AIDS
patients, and frequently leads to blindness if untreated. Intravitreal ganciclovir proved to be effective in
stopping the progression of the disease.
Objectives : To determine the efficacy and complications of intravitreal ganciclovir (2 mg in 0.1 ml per injec-
tion) to control CMV retinitis.
Study
Design : A retrospective non-randomized interventional case series.
Materials and Methods : The participants were 363 consecutive patients with CMV retinitis treated at the CMV
Retinitis Clinic, Maharaj Nakorn Chiang Mai Hospital over the period from June 2001 to December 2003.The
affected eyes received weekly intravitreal injections of 2 mg of ganciclovir until the lesions were inactive, then
2-4 weeks each time continuously or until relapse. If the lesions relapsed, then the weekly schedule was
re-started.
Results : In 568 treated eyes at the time of last follow up, visual acuity remained stable in 343 (60 %), improved
in 76(13 %), and decreased in 149 (26 %). Of these, 33 retinal detachments, 6 intravitreal hemorrhages, 6
endophthalmitis, and 2 cataract occurred. Bilateral disease occurred in 22% of patients who first came with
unilateral involvement.
Conclusion : Intravitreal ganciclovir appeared to be a worthwhile therapeutic alternative for CMV retinitis
patients with unaffordable or intolerant to systemic anti-CMV therapy, but the complications of intravitreal
injections should also be recognized.
Keywords : Acquired immunodeficiency syndrome (AIDS), Cytomegalovirus (CMV), Retinitis, Ganciclovir, Intravitreal injection
