Cytomegalovirus papillitis in patients with acquired immune deficiency syndrome. Visual prognosis of patients treated with ganciclovir and/or foscarnet.
BACKGROUND
Of those patients with acquired immune deficiency syndrome in whom cytomegaloviral retinitis develops, cytomegaloviral papillitis reportedly develops in up to 4% as well. Although occasionally patients have a good visual outcome, the majority have a poor visual prognosis, with a visual acuity of 20/200 or worse, even with treatment.


METHODS
To evaluate the effects of prolonged induction with foscarnet or ganciclovir on the visual prognosis of cytomegalovirus (CMV) papillitis, the records of 22 patients seen between 1990 and 1995 at the Los Angeles County-University of Southern California Eye Clinic were reviewed. Papillitis was defined as greater than 270 degrees of disc edema/blurring of the disc margins as seen on direct examination and on color fundus photographs.


RESULTS
Eighteen patients with a mean initial visual acuity of 20/69 (range, 20/ 15-20/400) were treated with induction doses of intravenous ganciclovir (range, 5-7.5 mg/kg twice daily) or foscarnet (range, 60-90 mg/kg twice or 3 times daily) for a mean of 3.3 weeks. The mean follow-up period was 4.8 months (range, 1-13 months). These patients maintained a mean final visual acuity of 20/68 (range, 20/ 25-20/400) with greater than 90% resolution of the papillitis. The remaining four patients had poor outcomes (visual acuity < 20/400) because of progressive CMV papillitis or retinitis. The median survival time was 4.5 months from the diagnosis of papillitis, but 7 months from the onset of CMV ocular infection.


CONCLUSIONS
Patients with CMV papillitis have good visual prognosis when managed with high and prolonged doses of intravenous foscarnet and/or ganciclovir.
Patel
S S
SS
Doheny Eye Institute, University of Southern California School of Medicine, Los Angeles, USA.
Rutzen
A R
AR
Marx
J L
JL
Thach
A B
AB
Chong
L P
LP
Rao
N A
NA
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000503:physiopathology; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D003586:Cytomegalovirus Infections / Q000188:drug therapy* / Q000503:physiopathology; D017726:Cytomegalovirus Retinitis / Q000188:drug therapy / Q000503:physiopathology; D004359:Drug Therapy, Combination; D015828:Eye Infections, Viral / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D017245:Foscarnet / Q000627:therapeutic use*; D005654:Fundus Oculi; D015774:Ganciclovir / Q000627:therapeutic use*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009898:Optic Disk / Q000473:pathology; D009902:Optic Neuritis / Q000188:drug therapy* / Q000503:physiopathology / Q000821:virology; D011379:Prognosis; D014792:Visual Acuity
D000998:Antiviral Agents; D017245:Foscarnet; D015774:Ganciclovir