title: Treatment of clinically resistant cytomegalovirus retinitis with combined intravitreal injections of ganciclovir and foscarnet.
abstract: OBJECTIVE
  To determine the efficacy of combined ganciclovir and foscarnet intravitreal injections in controlling clinically resistant cytomegalovirus retinitis in a 37-year-old man with the acquired immunodeficiency syndrome who refused systemic therapy.
  
  
  METHODS
  The patient refused systemic therapy and was treated with intravitreal injections of ganciclovir and foscarnet, which were then combined when the retinitis became resistant to either drug alone.
  
  
  RESULTS
  The retinitis was initially controlled with bilateral intravitreal ganciclovir injections. After reactivation of retinitis in the left eye, intravitreal foscarnet was effective until recurrent retinitis threatened the center of the fovea. The retinitis continued to progress until combined intravitreal injections of ganciclovir and foscarnet were administered.
  
  
  CONCLUSIONS
  Combined intravitreal injections of ganciclovir and foscarnet may be effective in treating cytomegalovirus retinitis when the infection is clinically resistant to either intravitreal drug alone. Intravitreal injections can be effective in controlling cytomegalovirus retinitis in patients who are intolerant of or refuse systemic therapy.
authors.affiliation: Division of Ophthalmology, Cleveland Clinic Foundation, OH 44195-5024, USA. Fosterr@cesmtp.ccf.org
authors.forename: H R
authors.initials: HR
authors.lastname: Desatnik
authors.forename: R E
authors.initials: RE
authors.lastname: Foster
authors.forename: C Y
authors.initials: CY
authors.lastname: Lowder
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003587:Cytomegalovirus / Q000187:drug effects; D017726:Cytomegalovirus Retinitis / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D004352:Drug Resistance, Microbial; D004359:Drug Therapy, Combination; D017245:Foscarnet / Q000008:administration & dosage / Q000627:therapeutic use*; D015774:Ganciclovir / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007267:Injections; D008297:Male; D012008:Recurrence; D014822:Vitreous Body
chemical_list: D000998:Antiviral Agents; D017245:Foscarnet; D015774:Ganciclovir