November 1997

Ganciclovir Implant ExchangeTiming, Surgical Procedure, and Complications

Author Affiliations

From the Department of Ophthalmology, Emory University School of Medicine, Atlanta, Ga (Dr Martin and Ms Gibbs); The National Eye Institute, National Institutes of Health, Bethesda, Md (Drs Martin, Ferris, Parks, Walton, Chan, Nussenblatt, and Mss Mellow and Remaley); New England Eye Center, Boston, Mass (Dr Ashton); and the Department of Ophthalmology, University of Wisconsin, Madison (Dr Davis). Expenses for patient travel were defrayed in part by Chiron Vision Inc, Irvine, Calif.; Dr Ashton has a proprietary interest in the ganciclovir implant.

Arch Ophthalmol. 1997;115(11):1389-1394. doi:10.1001/archopht.1997.01100160559005

Background:  The ganciclovir implant is effective for the treatment of cytomegalovirus (CMV) retinitis. The device eventually runs out of drug, however, and must be replaced. We report our experience with exchanging ganciclovir implants during the course of a randomized clinical trial.

Methods:  During our study, patients with newly diagnosed peripheral CMV retinitis were treated with a ganciclovir implant. The implant was scheduled for exchange at 32 weeks. It was exchanged earlier if progression of CMV retinitis occurred. Patient examinations and standard fundus photography were performed at 2-week intervals after the exchange procedure.

Results:  Twenty-six exchange procedures were performed. Twenty-two eyes in 15 patients received a second implant and 4 eyes in 4 patients later received a third implant. Cytomegalovirus retinitis was rendered or maintained inactive in 22 of 23 cases with more than 1 month of follow-up after the second or third implants. Complications after the second implant procedure included transient vitreous hemorrhage in 5 eyes, postoperative inflammation in 1 eye, and retinal detachment in 1 eye. Median visual acuity returned to 20/25 by 28 days and to 20/20 by 42 days. Complications after the third implant procedure included dense vitreous hemorrhage in 3 of 4 eyes. Median survival time after a second implant procedure was 89 days.

Conclusions:  The initial ganciclovir implant exchange procedure is well tolerated with continued long-term control of CMV retinitis. Multiple reentries through the same wound may be associated with an increased risk for vitreous hemorrhage.