October 15, 1997

Cytomegalovirus Retinitis TreatmentAbstract and Commentary

Author Affiliations

Associate Professor of Medicine Co-Director, Division of Infectious Diseases Washington University School of Medicine St Louis, Mo

JAMA. 1997;278(15):1287. doi:10.1001/jama.1997.03550150091044

Background:  Sustained-release, intraocular implants that deliverganciclovir are an alternative method for the treatment of cytomegalovirus retinitis in patients with the acquired immunodeficiency sydrome (AIDS).

Methods:  We conducted a randomized study of 188 patients with AIDS and newly diagnosed cytomegalovirus retinitis. The patients were randomly assigned to treatment with an implant delivering 1μg of ganciclovir per hour, an implant delivering 2μg of ganciclovir per hour, or intravenous ganciclovir. The primary outcome we studied was propression of cytomegalovirus retinitis.

Results:  The median time to propression of retinitis was 221 days with the 1-μg-per-hour implant (75 eyes), 191 days with ganciclovir administered intravenously (76 eyes; P<0.001). The risk of progression of retinitis was almost three times as great among patients treated with intrave-nous ganciclovir as among those treated with a ganciclovir implant (risk ratio, 2.8; P<0.001). However, the risk of disease in the initially uninvolved eye was lower with intravenous ganciclovir than with a ganciclovir implant (risk ratio, 0.5; P=0.19). Patients treated with intravenous ganciclovir were also less likely to the have extraocular cytomegalovirus infection (0, vs. 10.3 percentin the two implant groups; P=0.04).

Conclusions:  For the treatment of cytomegalovirus retinitis, thesustained releasse ganciclovir implant is more effective than intravenous ganciclovir, but patients treated with a ganciclovir implant alone remain at greater risk for the development of cytomegalovirus disease outside of the treated eye.