Treatment outcomes of reduced-dose intravitreal ganciclovir for cytomegalovirus retinitis

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.

Extralesional microvascular and structural macular abnormalities in cytomegalovirus retinitis

“…The optimal regimen should balance between efficacy, treatment burden and potential retinal toxicity from prolonged and repeated injections [22][23][24] . The regimen used in this study has been demonstrated to be clinically effective and safe 25 . Nevertheless, no studies have evaluated the effects of intravitreal ganciclovir on microvascular retinal blood flow.…”

Does ganciclovir exert retinal toxicity after multiple continuous intravitreal injections?

“…The recommended dosage of intravitreal ganciclovir used to treat herpetic uveitis is 200–400 μg/0.1 ml. Intravitreal ganciclovir injection at doses of 1 mg, 2 mg, 3 mg and 5 mg has also been used to treat ARN and CMVR [ 2 , 6 – 8 ]. In one prospective interventional case series, intravitreal ganciclovir injection of 5 mg/0.1 ml once a week was used to treat active CMVR, and no retinal toxicity was observed [ 2 ].…”

Synthesis of New Imidazopyridine Nucleoside Derivatives Designed as Maribavir Analogues

“…Ganciclovir (GCV) and its orally bioavailable prodrug, Valganciclovir, have served as gold standards for pre-emptive therapy and prophylaxis against HCMV in solid organ transplant patients [ 6 ] as well as for the treatment of CMV retinitis [ 7 ] for almost 30 years. However, their myelosuppressive potential precludes their prophylactic use in stem cell transplant recipients, which has led to their administration, mostly upon engraftment [ 8 ].…”