Publication: Treatment outcomes of reduced-dose intravitreal ganciclovir for cytomegalovirus retinitis
Issued Date
2016
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eng
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Mahidol University
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BioMed Central
Bibliographic Citation
BMC Infectious Diseases. Vol. 16, (2016), 164
Suggested Citation
Pitipol Choopong, Kamolporn Vivittaworn, Duanphen Konlakij, Somanus Thoongsuwan, Auengporn Pituksung, Nattaporn Tesavibul Treatment outcomes of reduced-dose intravitreal ganciclovir for cytomegalovirus retinitis. BMC Infectious Diseases. Vol. 16, (2016), 164. doi:10.1186/s12879-016-1490-6 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/2677
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Title
Treatment outcomes of reduced-dose intravitreal ganciclovir for cytomegalovirus retinitis
Abstract
Background: Cytomegalovirus 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.
Methods: A 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.
Results: Twenty 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.
Conclusions: Reduced-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 registration: The trial was registered with Thai Clinical Trials Registry (TCTR) on 16 March 2016 – TCTR20160316001.