title: Ganciclovir implant exchange. Timing, surgical procedure, and complications.
abstract: 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.
authors.affiliation: Department of Ophthalmology, Emory University School of Medicine, Atlanta, Ga., USA.
authors.forename: D F
authors.initials: DF
authors.lastname: Martin
authors.forename: F L
authors.initials: FL
authors.lastname: Ferris
authors.forename: D J
authors.initials: DJ
authors.lastname: Parks
authors.forename: R C
authors.initials: RC
authors.lastname: Walton
authors.forename: S D
authors.initials: SD
authors.lastname: Mellow
authors.forename: D
authors.initials: D
authors.lastname: Gibbs
authors.forename: N A
authors.initials: NA
authors.lastname: Remaley
authors.forename: P
authors.initials: P
authors.lastname: Ashton
authors.forename: M D
authors.initials: MD
authors.lastname: Davis
authors.forename: C C
authors.initials: CC
authors.lastname: Chan
authors.forename: R B
authors.initials: RB
authors.lastname: Nussenblatt
mesh_terms: D000998:Antiviral Agents / Q000008:administration & dosage* / Q000009:adverse effects; D017726:Cytomegalovirus Retinitis / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D004343:Drug Implants; D015774:Ganciclovir / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D013508:Ophthalmologic Surgical Procedures; D011183:Postoperative Complications; D012086:Reoperation; D012449:Safety; D015996:Survival Rate; D013997:Time Factors; D014792:Visual Acuity; D014822:Vitreous Body / Q000187:drug effects
chemical_list: D000998:Antiviral Agents; D004343:Drug Implants; D015774:Ganciclovir