title: Multiple intravitreal injections of ganciclovir for cytomegalovirus retinitis after stem-cell transplantation.
abstract: BACKGROUND
  Cytomegalovirus (CMV) infection is a major cause of morbidity and mortality in patients after hematopoietic stem cell transplantation (HSCT). Although much effort has been put into dealing with CMV retinitis secondary to acquired immunodeficiency syndrome (AIDS), the few reports which have been published have mainly focused on treatment of CMVR after HSCT.
  
  
  METHODS
  This clinical interventional retrospective study included 14 patients (eight men; mean age 23.89 ± 12.09; 23 eyes) who suffered from CMV retinitis after stem-cell transplantation, in order to evaluate the efficacy and safety of multiple intravitreal injections of ganciclovir (IVG) for patients with CMV retinitis. All patients received 4 injections of IVG of 1 mg at 1 week intervals, and were followed up weekly for at least 2 months with measurement of best-corrected visual acuity (BCVA) and CMV levels in anterior aqueous humor with real-time polymerase chain reaction. Anterior aqueous humor was obtained before each injection.
  
  
  RESULTS
  The levels of CMV in anterior aqueous humor showed significant decrease from (6.34 ± 15.78) × 10(5) copies/ml at baseline to (5.22 ± 12.15) × 10(3) copies/ml at 1 month (P < 0.001, Mann-Whitney U test). CMV couldn't be detected in 11 eyes (47.8 %) after two injections, and this rose to 18 eyes (78.3 %) at 1 month. The mean logMAR BCVA was 0.659 ± 0.572 at baseline and 0.680 ± 0.527 at 2 months, which suggested no significant improvement (P = 0.736, Mann-Whitney U test) during the procedure. All patients experienced improved vitreous opacity and diminished area of the lesion under funduscopy after 4 injections of IVG. No severe complications developed.
  
  
  CONCLUSIONS
  Multiple IVG seemed to be beneficial for patients with CMV retinitis after stem-cell transplantation, in reducing CMV levels in aqueous humor. Further study to optimize the dose of ganciclovir is needed in order to achieve better treatment outcomes.
authors.affiliation: Department of Ophthalmology, People's Hospital, Key Laboratory of Vision Loss and Restoration, Ministry of Education, Peking University, 11 Xizhimen South Street, Xicheng District, 100044, Beijing, China.
authors.forename: Heng
authors.initials: H
authors.lastname: Miao
authors.forename: Yong
authors.initials: Y
authors.lastname: Tao
authors.forename: Yan-Rong
authors.initials: YR
authors.lastname: Jiang
authors.forename: Xiao-Xin
authors.initials: XX
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D001082:Aqueous Humor / Q000821:virology; D002648:Child; D002675:Child, Preschool; D003587:Cytomegalovirus / Q000302:isolation & purification; D017726:Cytomegalovirus Retinitis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D010750:Phosphoproteins / Q000235:genetics; D012333:RNA, Messenger / Q000032:analysis; D012367:RNA, Viral / Q000235:genetics; D060888:Real-Time Polymerase Chain Reaction; D019233:Retreatment; D012189:Retrospective Studies; D014763:Viral Matrix Proteins / Q000235:genetics; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D010750:Phosphoproteins; D012333:RNA, Messenger; D012367:RNA, Viral; D014763:Viral Matrix Proteins; C464963:pp67 protein, human cytomegalovirus; D015774:Ganciclovir