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Treatment outcomes of reduced-dose intravitreal ganciclovir for cytomegalovirus retinitis.

Choopong P, Vivittaworn K, Konlakij D, Thoongsuwan S, Pituksung A, Tesavibul N - BMC Infect. Dis. (2016)

Bottom Line: Intravitreal ganciclovir injection has been used successfully but no standard regimen was established.Reduced-dose intravitreal ganciclovir is a safe and effective treatment option.It provides comparable results to other weekly regimens.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand. pitipol.cho@mahidol.edu.

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 .

No MeSH data available.


Related in: MedlinePlus

Kaplan–Meier graph showing complete resolution of cytomegalovirus (CMVR) lesions in eyes that received reduced-dose intravitreal ganciclovir injection alone, compared with eyes that received reduced-dose intravitreal combined with intravenous ganciclovir injection
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Fig1: Kaplan–Meier graph showing complete resolution of cytomegalovirus (CMVR) lesions in eyes that received reduced-dose intravitreal ganciclovir injection alone, compared with eyes that received reduced-dose intravitreal combined with intravenous ganciclovir injection

Mentions: Kaplan–Meier survival analysis showed that the regimen reached a median resolution time at 111.00 ± 12.82 days (95 % CI; 85.88–136.12). There was no significant difference in resolution time whether or not the patient received IVG induction treatment (p = 0.8, log-rank test) (Fig. 1). Multivariate Cox regression analysis indicated a shorter resolution time in patients initially presenting with an age younger than 45 years (HR 0.40; 95 % CI 0.17–0.93, p = 0.03), with no vasculitis (HR 3.45; 95 % CI 1.52–7.83, p = 0.003), or with no foveal involvement (HR 2.65; 95 % CI 1.14–6.11, p = 0.023) (Table 3). The VA stabilization or improvement was affected by the absence of vasculitis (HR 2.55; 95%CI 1.30–5.00, p = 0.007) and by the absence of retinitis in zone 1 (HR 0.51; 95 % CI 0.28–0.94, p = 0.03) (Table 4).Fig. 1


Treatment outcomes of reduced-dose intravitreal ganciclovir for cytomegalovirus retinitis.

Choopong P, Vivittaworn K, Konlakij D, Thoongsuwan S, Pituksung A, Tesavibul N - BMC Infect. Dis. (2016)

Kaplan–Meier graph showing complete resolution of cytomegalovirus (CMVR) lesions in eyes that received reduced-dose intravitreal ganciclovir injection alone, compared with eyes that received reduced-dose intravitreal combined with intravenous ganciclovir injection
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4836083&req=5

Fig1: Kaplan–Meier graph showing complete resolution of cytomegalovirus (CMVR) lesions in eyes that received reduced-dose intravitreal ganciclovir injection alone, compared with eyes that received reduced-dose intravitreal combined with intravenous ganciclovir injection
Mentions: Kaplan–Meier survival analysis showed that the regimen reached a median resolution time at 111.00 ± 12.82 days (95 % CI; 85.88–136.12). There was no significant difference in resolution time whether or not the patient received IVG induction treatment (p = 0.8, log-rank test) (Fig. 1). Multivariate Cox regression analysis indicated a shorter resolution time in patients initially presenting with an age younger than 45 years (HR 0.40; 95 % CI 0.17–0.93, p = 0.03), with no vasculitis (HR 3.45; 95 % CI 1.52–7.83, p = 0.003), or with no foveal involvement (HR 2.65; 95 % CI 1.14–6.11, p = 0.023) (Table 3). The VA stabilization or improvement was affected by the absence of vasculitis (HR 2.55; 95%CI 1.30–5.00, p = 0.007) and by the absence of retinitis in zone 1 (HR 0.51; 95 % CI 0.28–0.94, p = 0.03) (Table 4).Fig. 1

Bottom Line: Intravitreal ganciclovir injection has been used successfully but no standard regimen was established.Reduced-dose intravitreal ganciclovir is a safe and effective treatment option.It provides comparable results to other weekly regimens.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand. pitipol.cho@mahidol.edu.

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 .

No MeSH data available.


Related in: MedlinePlus