Treatment of cytomegalovirus retinitis in AIDS patients using intravitreal injections of highly concentrated ganciclovir

Purpose: Intravitreal injections of ganciclovir provide a useful adjunct or alternative treatment for cytomegalovirus retinitis in AIDS patients when toxicity or progression is seen with systemic administration of antiviral drugs. To avoid transient increase in intraocular pressure that may impair optic nerve vascularization in long-term treated patients, we modified conventional procedures by injecting a smaller volume of a more concentrated ganciclovir solution. Patients and Methods: We used intravitreal injections of 350 mu g of ganciclovir in a final volume of 50 mu k, in 156 eyes from 111 AIDS patients, 14-53 years old, presenting with necrotizing retinitis despite systemic antiviral agents or who had become intolerant to systemic treatment. Results: Patients underwent a total of 2,890 injections. The mean number of injections was 25.9+/-3.2 by patient, with a maximal duration of 32 months (with a total of 220 injections in 1 patient). Forty-five of the 111 patients received bilateral intravitreal injections, 8 had more than 80 injections each. The only major complications were 4 cases of endophthalmitis causing a total loss of-vision in 2 eyes, 1 retinal detachment and 3 cases of slow progression of retinitis resulting in optic nerve atrophy despite treatment. We observed a very low rate of amaurosis and ocular pain. Relapse occurred after 2-3 weeks whenever treatment was stopped, so that intravitreal ganciclovir was not discontinued until the patient's death or reintroduction of-systemic treatment. Conclusions: This procedure confirmed the good efficacy of intravitreal ganciclovir in halting progression of retinitis. Injection of-a smaller volume of ganciclovir reduced repeated amaurosis and ocular pain. It was considered by patients as improving their comfort and quality of life, thus increasing their compliance to treatment and reducing side effects as compared to usual protocols.