Complications of ganciclovir implant surgery in patients with cytomegalovirus retinitis: the Ganciclovir Cidofovir Cytomegalovirus Retinitis Trial.
OBJECTIVE
To describe the complications of ganciclovir implant surgery in patients with cytomegalovirus retinitis.


METHODS
Prospective data collection within the context of a randomized, controlled clinical trial, comparing a regimen of the ganciclovir implant plus oral ganciclovir to one of intravenous cidofovir for the treatment of cytomegalovirus retinitis in patients with AIDS. Adverse events were compared for patients undergoing implant surgery in the following groups: primary versus replacement implant surgery, inpatient versus outpatient surgery, and general versus local anesthesia.


RESULTS
Fifty-six eyes of 42 patients underwent a total of 74 ganciclovir implant surgeries. Vitreous hemorrhage was the most common adverse event, occurring in 10% of eyes undergoing surgery with local anesthesia but in no eyes undergoing surgery with general anesthesia. All vitreous hemorrhages resolved within 60 days. Patients in the general anesthesia and inpatient surgery groups tended to have a lower risk of complications in the first 30 days than did patients in the local anesthesia and outpatient surgery groups, but no differences in the complication rate were found after 60 days. Visual acuity was similar among these different groups. There were no cases of endophthalmitis.


CONCLUSIONS
Ganciclovir implant surgery in patients with AIDS and cytomegalovirus retinitis was associated with a low risk of serious complications in the first 60 days after surgery. Vitreous hemorrhage was the most commonly observed complication and resolved in all cases.
Dunn
James P
JP
Department of Ophthalmology, Wilmer Eye Institute, The Johns Hopkins University School of Medicine, 550 North Broadway, Baltimore, MD 21205, USA.
Van Natta
Mark
M
Foster
Gregory
G
Kuppermann
Baruch D
BD
Martin
Daniel F
DF
Zong
Alice
A
Jabs
Douglas A
DA
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy*; D000284:Administration, Oral; D000328:Adult; D000768:Anesthesia, General; D000772:Anesthesia, Local; D000998:Antiviral Agents / Q000627:therapeutic use*; D000077404:Cidofovir; D017726:Cytomegalovirus Retinitis / Q000188:drug therapy*; D003596:Cytosine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004343:Drug Implants / Q000009:adverse effects*; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use; D006801:Humans; D007262:Infusions, Intravenous; D007431:Intraoperative Complications; D008297:Male; D063065:Organophosphonates; D009943:Organophosphorus Compounds / Q000627:therapeutic use; D011183:Postoperative Complications; D011446:Prospective Studies; D014792:Visual Acuity; D014823:Vitreous Hemorrhage / Q000209:etiology
D000998:Antiviral Agents; D004343:Drug Implants; D063065:Organophosphonates; D009943:Organophosphorus Compounds; D003596:Cytosine; D000077404:Cidofovir; D015774:Ganciclovir