Complications after implantation of intraocular devices in patients with cytomegalovirus retinitis.
OBJECTIVE
The authors report their surgical experience after sustained-release ganciclovir treatment, as well as replacing empty ganciclovir implants in patients with acquired immune deficiency syndrome (AIDS) and cytomegalovirus (CMV) retinitis.


METHODS
Between November 1995 and August 1998, 79 eyes of 49 patients received 99 intravitreal ganciclovir implants. Patients were examined monthly after implant surgery. Follow-up periods ranged from 6 to 128 weeks.


RESULTS
At the first 3-week postoperative visit, 73 eyes (97.2%) of 46 patients exhibited stable conditions. In 6 eyes (3.8%) of 3 patients, further progression was noted due to resistance to ganciclovir. The most common early complication (within 6 weeks after implantation) was cystoid macular edema, observed in 7 eyes receiving implants. Retinal detachment was the most common late complication (over 6 weeks after implantation) in 11 eyes. In almost all eyes with CMV retinitis and retinal detachment, involvement of more than 25% of the retina was observed. Additional severe complications included extrusion of the first pellet in 2 eyes and cataract as a late complication in 5 eyes. A total of 28 eyes (35.4%) of 16 patients receiving a second implant did not experience significant three-line loss by the end of the follow-up period.


CONCLUSIONS
In the treatment of CMV retinitis, sustained-release ganciclovir implantation seems to be an alternative to intravenous ganciclovir. Early implantation and additional replacement of the device has the potential to decrease the risk of developing retinal detachment. We would recommend additional systemic antiviral CMV therapy to avoid infection of the fellow eye and CMV disease.
Guembel
H O
HO
Department of Ophthalmology, University Clinics Frankfurt/Main, Theodor-Stern-Kai 7, D-60590 Frankfurt/Main, Germany.
Krieglsteiner
S
S
Rosenkranz
C
C
Hattenbach
L O
LO
Koch
F H
FH
Ohrloff
C
C
D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000188:drug therapy*; D000293:Adolescent; D000328:Adult; D000914:Antibodies, Viral / Q000032:analysis; D000998:Antiviral Agents / Q000008:administration & dosage*; D003587:Cytomegalovirus / Q000276:immunology; D017726:Cytomegalovirus Retinitis / Q000150:complications / Q000188:drug therapy*; D004343:Drug Implants / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D015774:Ganciclovir / Q000008:administration & dosage*; D006678:HIV / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012163:Retinal Detachment / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D012189:Retrospective Studies; D014821:Vitrectomy; D014822:Vitreous Body / Q000601:surgery / Q000821:virology
D000914:Antibodies, Viral; D000998:Antiviral Agents; D004343:Drug Implants; D015774:Ganciclovir