The High-Dose, Alternate-Week Intravitreal Ganciclovir Injections for Cytomegalovirus Retinitis in Acquired Immune Deficiency Syndrome Patients on Highly Active Antiretroviral Therapy
Kanokwan Yutthitham MD*, Paisan Ruamviboonsuk MD*
Affiliation : * Department of Ophthalmology, Rajavithi Hospital
Objectives : To evaluate the efficacy, and complications of the high-dose, alternate-week, intravitreal ganciclovir
injection for cytomegaloviral retinitis (CMVR) in acquired immune deficiency syndrome (AIDS) patients on
highly active antiretroviral therapy (HAART).
Design : Retrospective case series.
Participants: AIDS patients with CMVR and on HAART.
Materials and Methods : The high-dose, 4 mg/0.1 ml, ganciclovir was injected intravitreally to the enrolled
patients on an alternate-week basis. The patients were monitored clinically until the retinitis was inactive,
then the injections were withdrawn. The injections were re-initiated if relapse occurred.
Main Outcome Measures: The number of eyes achieved inactive retinitis and corresponded to the number of
injections, number of relapses and corresponded duration, visual acuity during the injection, and complications
of the injection.
Results : Inactive lesions were found in 42/51 eyes (82.4%), the corresponding mean number of injections was
5.4 (1-18) per eye. There was no relapse and the corresponded duration of follow-up was 5.1 months (1-16).
The final visual outcomes were improved or stable in 26 eyes (50.9%). These visual outcomes were statistically
related to initial visual acuity (p = 0.022) but not statistically related to the number of injections (p = 0.929).
Complications were found in 7/51 eyes (13.7%). They were vitreous haze, immune recovery uveitis,
rhegmatogenous retinal detatchment, and infectious endophthalmitis.
Conclusion : The high-dose, alternate-week, intravitreal injection of ganciclovir may be an alternative for the
treatment of CMVR in AIDS patients who are on HAART. However, the induction course is longer than the
weekly regimen and close monitoring of patients is essential.
Keywords : CMVR, HAART, AIDS, Intravitreal ganciclovir, Ganciclovir
