Abstract
BackgroundCytomegalovirus retinitis (CMVR) is one of the most common opportunistic infection in immunocompromised individuals. Intravitreal ganciclovir injection has been used successfully but no standard regimen was established. Risks of drug toxicity, endophthalmitis, and injection-related complications increased with number and frequency of injection. The aim of this study is to evaluate the outcomes of reduced-dose intravitreal ganciclovir (2 mg/0.04 mL) for the treatment of CMVR.MethodsA prospective observational cohort study involving 67 eyes of 49 patients with CMVR was performed. Induction therapy involved intravenous ganciclovir (10 mg/kg/day) for 2 weeks unless contraindicated or patients refused. Patients were then treated with reduced-dose intravitreal ganciclovir every week for 4 weeks, and then every other week until the lesion healed. The patients’ demographic data were recorded, and vision parameters were examined every visit.ResultsTwenty eyes (29.9 %) presented with initial visual acuities less than 6/60. The majority of patients were diagnosed with CMVR in zones 1 or 2 (63 eyes, 94 %), and, at least, one quadrant of the retina was involved (56 eyes, 83.6 %). Forty-one eyes (61.2 %) completely resolved after treatment within the 6-month follow-up. There was no significant difference in healing time, whether or not patients received induction treatment with intravenous ganciclovir (111.00 ± 12.96 vs 105.00 ± 28.32 days, p = 0.8). Five eyes (12.2 %) of patients with healed CMVR had visual acuities less than 6/60.ConclusionsReduced-dose intravitreal ganciclovir is a safe and effective treatment option. It provides comparable results to other weekly regimens. Induction with intravenous ganciclovir is not crucial in a resolution of retinitis, although it may be necessary to reduce systemic cytomegalovirus loads and mortality rates.Trial registrationThe trial was registered with Thai Clinical Trials Registry (TCTR) on 16 March 2016 – TCTR20160316001.
Highlights
Cytomegalovirus retinitis (CMVR) is one of the most common opportunistic infection in immunocompromised individuals
There was no standard regimen in the treatment of CMVR with intravitreal ganciclovir injection
High dose (4 mg) ganciclovir could result in toxicity, for example, we reported a case of crystallization of 4-mg intravitreal ganciclovir injection leading to retinal arterial occlusion and optic atrophy [13]
Summary
Cytomegalovirus retinitis (CMVR) is one of the most common opportunistic infection in immunocompromised individuals. The Food and Drug Administration of the US has approved two routes of administration of ganciclovir for treatment of CMVR, an intravenous route and an Choopong et al BMC Infectious Diseases (2016) 16:164 intraocular implant. The need for retinal surgery and the high risk of retinal detachment make this method unfavourable. Intravitreal injection of ganciclovir (IVTG) has been introduced [5,6,7] This method is easy and safe and provides fast and high intraocular drug concentrations. There was no standard regimen in the treatment of CMVR with intravitreal ganciclovir injection. The potential complications from intraocular injection include endophthalmitis, vitreous haemorrhage, and retinal vascular occlusion; retinal detachment increases with increased numbers and frequencies of injection [12]
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