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. 1988 Jul;72(7):521–524. doi: 10.1136/bjo.72.7.521

Intravenous and intraocular ganciclovir for CMV retinitis in patients with AIDS or chemotherapeutic immunosuppression.

G L Daikos 1, J Pulido 1, S B Kathpalia 1, G G Jackson 1
PMCID: PMC1041517  PMID: 2843218

Abstract

The efficacy and toxicity of ganciclovir given by intravenous or intravenous plus intravitreal injection were studied in nine patients with cytomegalovirus (CMV) retinitis; seven with AIDS and two with drug induced immunodeficiency. Five patients had retinitis with macular involvement in six sighted eyes; six patients had only peripheral retinitis in seven eyes. In two patients (two eyes) with macular involvement intravenous plus intravitreal injection of ganciclovir preserved sight; intravenous infusion alone did not in four eyes of three other patients. In seven eyes (six patients) with peripheral retinitis vision was retained regardless of the route of ganciclovir treatment. Following intravenous ganciclovir drug levels in the vitreous fluid were 1.4-2.2 mmol/l, that is, 44 and 65% of the concomitant serum concentration. Clinically and at necropsy three eyes showed no evidence of toxicity from intravitreal injection of ganciclovir. All of five patients with AIDS who received intravenous ganciclovir for more than one week developed leucopenia. CMV retinitis of the macula may be benefited with minimal drug toxicity by intravitreal injection of ganciclovir. Treatment of peripheral CMV retinitis in patients with AIDS may be optional.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bach M. C., Bagwell S. P., Knapp N. P., Davis K. M., Hedstrom P. S. 9-(1,3-Dihydroxy-2-propoxymethyl)guanine for cytomegalovirus infections in patients with the acquired immunodeficiency syndrome. Ann Intern Med. 1985 Sep;103(3):381–382. doi: 10.7326/0003-4819-103-3-381. [DOI] [PubMed] [Google Scholar]
  2. Egbert P. R., Pollard R. B., Gallagher J. G., Merigan T. C. Cytomegalovirus retinitis in immunosuppressed hosts. II. Ocular manifestations. Ann Intern Med. 1980 Nov;93(5):664–670. doi: 10.7326/0003-4819-93-5-664. [DOI] [PubMed] [Google Scholar]
  3. Felsenstein D., D'Amico D. J., Hirsch M. S., Neumeyer D. A., Cederberg D. M., de Miranda P., Schooley R. T. Treatment of cytomegalovirus retinitis with 9-[2-hydroxy-1-(hydroxymethyl)ethoxymethyl]guanine. Ann Intern Med. 1985 Sep;103(3):377–380. doi: 10.7326/0003-4819-103-3-377. [DOI] [PubMed] [Google Scholar]
  4. Henry K., Cantrill H., Fletcher C., Chinnock B. J., Balfour H. H., Jr Use of intravitreal ganciclovir (dihydroxy propoxymethyl guanine) for cytomegalovirus retinitis in a patient with AIDS. Am J Ophthalmol. 1987 Jan 15;103(1):17–23. doi: 10.1016/s0002-9394(14)74163-7. [DOI] [PubMed] [Google Scholar]
  5. Holland G. N., Sakamoto M. J., Hardy D., Sidikaro Y., Kreiger A. E., Frenkel L. M. Treatment of cytomegalovirus retinopathy in patients with acquired immunodeficiency syndrome. Use of the experimental drug 9-[2-hydroxy-1-(hydroxymethyl)ethoxymethyl]guanine. Arch Ophthalmol. 1986 Dec;104(12):1794–1800. doi: 10.1001/archopht.1986.01050240068042. [DOI] [PubMed] [Google Scholar]
  6. Jabs D. A., Wingard J. R., de Bustros S., de Miranda P., Saral R., Santos G. W. BW B759U for cytomegalovirus retinitis: intraocular drug penetration. Arch Ophthalmol. 1986 Oct;104(10):1436–1437. doi: 10.1001/archopht.1986.01050220030009. [DOI] [PubMed] [Google Scholar]
  7. Palestine A. G., Rodrigues M. M., Macher A. M., Chan C. C., Lane H. C., Fauci A. S., Masur H., Longo D., Reichert C. M., Steis R. Ophthalmic involvement in acquired immunodeficiency syndrome. Ophthalmology. 1984 Sep;91(9):1092–1099. doi: 10.1016/s0161-6420(84)34201-4. [DOI] [PubMed] [Google Scholar]
  8. Palestine A. G., Stevens G., Jr, Lane H. C., Masur H., Fujikawa L. S., Nussenblatt R. B., Rook A. H., Manischewitz J., Baird B., Megill M. Treatment of cytomegalovirus retinitis with dihydroxy propoxymethyl guanine. Am J Ophthalmol. 1986 Jan 15;101(1):95–101. doi: 10.1016/0002-9394(86)90470-8. [DOI] [PubMed] [Google Scholar]
  9. Pepose J. S., Holland G. N., Nestor M. S., Cochran A. J., Foos R. Y. Acquired immune deficiency syndrome. Pathogenic mechanisms of ocular disease. Ophthalmology. 1985 Apr;92(4):472–484. doi: 10.1016/s0161-6420(85)34008-3. [DOI] [PubMed] [Google Scholar]
  10. Plotkin S. A., Drew W. L., Felsenstein D., Hirsch M. S. Sensitivity of clinical isolates of human cytomegalovirus to 9-(1,3-dihydroxy-2-propoxymethyl)guanine. J Infect Dis. 1985 Oct;152(4):833–834. doi: 10.1093/infdis/152.4.833. [DOI] [PubMed] [Google Scholar]
  11. Pollard R. B., Egbert P. R., Gallagher J. G., Merigan T. C. Cytomegalovirus retinitis in immunosuppressed hosts. I. Natural history and effects of treatment with adenine arabinoside. Ann Intern Med. 1980 Nov;93(5):655–664. doi: 10.7326/0003-4819-93-5-655. [DOI] [PubMed] [Google Scholar]
  12. Pulido J., Peyman G. A., Lesar T., Vernot J. Intravitreal toxicity of hydroxyacyclovir (BW-B759U), a new antiviral agent. Arch Ophthalmol. 1985 Jun;103(6):840–841. doi: 10.1001/archopht.1985.01050060100036. [DOI] [PubMed] [Google Scholar]
  13. Schulman J., Peyman G. A., Horton M. B., Liu J., Fiscella R., Pulido J., Barber J. C., de Miranda P. Intraocular 9-([2-hydroxy-1-(hydroxymethyl) ethoxy] methyl) guanine levels after intravitreal and subconjunctival administration. Ophthalmic Surg. 1986 Jul;17(7):429–432. [PubMed] [Google Scholar]

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