title: Intravitreal ganciclovir in the management of non-AIDS-related human cytomegalovirus retinitis.
abstract: OBJECTIVE
  To report and evaluate intravitreal ganciclovir injections in non-AIDS patients with human cytomegalovirus (HCMV) retinitis.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Two SLE patients and one patient post chemotherapy for a non Hodgkin's lymphoma presented with myelosuppression and persistent cytomegalovirus retinitis despite systemic ganciclovir therapy.
  
  
  METHODS
  Patients were treated with 100 microL of intravitreal ganciclovir (4 mg/dL), initially given weekly. Systemic anti-CMV medication was stopped, and following quiescence, intravitreal injections were tapered and ultimately stopped based on therapeutic response. Patients were followed periodically for signs of recurrence.
  
  
  RESULTS
  Intravitreal ganciclovir was well tolerated and led to remission of the retinitis in 2 patients. One patient had persistent smouldering disease and reached quiescence using an intravitreal ganciclovir implant. Fluorescence-activated cell sorting analysis in one patient showed the presence of low CD4 and CD8 while treated with systemic ganciclovir, which improved with intravitreal treatment. In another, the low ratio was maintained against cytomegalovirus-specific antigens.
  
  
  CONCLUSIONS
  Intravitreal ganciclovir injections should be considered as a treatment option in selected iatrogenically immunocompromised patients with HCMV retinitis. Responses may vary and will require an adjusted approach to treatment.
authors.affiliation: Department of Ophthalmology, Medical University of Graz, Graz, Austria.
authors.forename: Beate J
authors.initials: BJ
authors.lastname: Langner-Wegscheider
authors.forename: Ninette
authors.initials: N
authors.lastname: ten Dam-van Loon
authors.forename: Marco
authors.initials: M
authors.lastname: Mura
authors.forename: Koorosh
authors.initials: K
authors.lastname: Faridpooya
authors.forename: Marc D
authors.initials: MD
authors.lastname: de Smet
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage*; D018791:CD4 Lymphocyte Count; D016516:CD4-CD8 Ratio; D017726:Cytomegalovirus Retinitis / Q000188:drug therapy*; D005260:Female; D005434:Flow Cytometry; D015774:Ganciclovir / Q000008:administration & dosage*; D018023:HIV Seronegativity; D006801:Humans; D007267:Injections; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014822:Vitreous Body
chemical_list: D000998:Antiviral Agents; D015774:Ganciclovir