title: Intravitreal ganciclovir maintenance injection for cytomegalovirus retinitis: efficacy of a low-volume, intermediate-dose regimen.
abstract: OBJECTIVE
  To report the clinical outcomes of highly active antiretroviral therapy (HAART)-naïve, human immunodeficiency virus (HIV)-positive patients with newly diagnosed cytomegalovirus (CMV) retinitis receiving intravitreal injections of a low-volume intermediate maintenance dose (1.0 mg/0.02 ml) of ganciclovir.
  
  
  METHODS
  Nonrandomized, retrospective, interventional series.
  
  
  METHODS
  A consecutive cohort of 34 eyes from 24 HAART-naïve patients with AIDS and diagnosed with CMV retinitis by retinal specialists at the Singapore Communicable Disease Centre.
  
  
  METHODS
  Patients received a maintenance dose of 1.0 mg/0.02 ml of intravitreal ganciclovir once weekly after standard induction therapy with 2.0 mg/0.04 ml of twice weekly intravitreal ganciclovir.
  
  
  METHODS
  Time to progression, visual acuity, and complications. Progression was observed using photographic documentation.
  
  
  RESULTS
  The median time to progression was 152 days (mean, 380.1 days, 95% confidence interval, 240.8-519.4). The median follow-up was 95 days (mean, 207.9 days). Three eyes developed rhegmatogenous detachments, but there was no endophthalmitis after 1858 injections. Contralateral involvement of CMV retinitis occurred in 17.6% of the patients. The cost estimate for intravitreal injections over a 6-month period was 11.7% that of sustained-release implants for unilateral treatment and 11.1% that of daily continuous intravenous infusions and oral valganciclovir compared with bilateral treatments.
  
  
  CONCLUSIONS
  Weekly low-volume, intermediate-dose (1.0 mg/0.02 ml) ganciclovir is an efficacious option in developing countries where newer options of sustained-release implants and oral valganciclovir are unavailable or prohibitively expensive. The regimen maintains a long time to progression, preserving vision while minimizing retinal toxicity complications.
authors.affiliation: National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Republic of Singapore.
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Teoh
authors.forename: Xiaoling
authors.initials: X
authors.lastname: Ou
authors.forename: Tock H
authors.initials: TH
authors.lastname: Lim
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000191:economics; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000191:economics; D017726:Cytomegalovirus Retinitis / Q000188:drug therapy* / Q000191:economics; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D015774:Ganciclovir / Q000008:administration & dosage* / Q000191:economics; D017048:Health Care Costs; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D012163:Retinal Detachment / Q000191:economics / Q000503:physiopathology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology
chemical_list: D000998:Antiviral Agents; D015774:Ganciclovir