Journal List > J Korean Ophthalmol Soc > v.57(2) > 1010513

Jang and Heo: Safety and Efficacy of Intravitreal Ganciclovir Injections More than 10 Times for Cytomegalovirus Retinitis

Abstract

Purpose

To study the treatment outcomes in patients who were administered multiple intravitreal ganciclovir injections more than 10 times alone without systemic anti-cytomegalovirus therapy for cytomegalovirus retinitis.

Case summary

A 64-year-old man who underwent immunosuppressive therapy after thymectomy due to an invasive thymoma and pure red-cell aplasia, a 60-year-old woman who underwent chemotherapy after diagnosis of diffuse large B-cell lymphoma, a 49-year-old man with a history of bone marrow transplantation due to acute myeloid leukemia, a 29-year-old woman with dermatomyositis treated with oral steroids and cyclosporine, and a 47-year-old woman who received intravitreal dexamethasone implant injections, intravitreal and subtenon steroid injections due to Behcet's disease were diagnosed with cytomegalovirus retinitis. All patients showed systemic complications such as pancytopenia after systemic anti-cytomegalovirus therapy, and therefore, they were administered multiple intravitreal ganciclovir injections alone. Best-corrected visual acuities improved in all patients, except in one case, where viral lesions were observed in the fovea. Retinal hemorrhaging and infiltrative lesions decreased in all patients. No severe complication was observed during the injection and in the follow-up period.

Conclusions

Multiple intravitreal ganciclovir injections alone can be used as a treatment modality for cytomegalovirus retinitis to avoid the systemic side effects of systemic anti-cytomegalovirus therapy.

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Figure 1.
Fundus photographs of left eye in case 1 patient. (A) Photograph showing whitish opaque lesions at the temporal side of retina. (B) Photograph of the same patients showing decreased lesion after intravitreal ganciclovir injection (cataract developing after the ganciclovir injection blocks the clear image).
jkos-57-316f1.tif
Figure 2.
Fundus photographs of both eye in case 2 patient. (A) Fundus photograph showing whitish retinal lesion and retinal hemorrhages along the inferior vascular arcade. (B) After intravitreal ganciclovir injection, the retinal lesion and hemorrhages were dimin-ished leaving a few white scars. (C) A whitish retinal lesion was spotted at inferior side of macula in the left eye. (D) Retinal lesion was disappeared leaving small retinal atrophy.
jkos-57-316f2.tif
Figure 3.
Fundus photographs of right eye in case 3 patient. (A) Fundus photograph showing whitish retinal lesion and vascular sheathing along the inferior vascular arcade. (B) Retinal lesion was disappeared after intravitreal ganciclovir injection leaving multiple chorioretinal atrophy.
jkos-57-316f3.tif
Figure 4.
Fundus photographs of right eye in case 4 patient. (A) Fundus photograph showing whitish retinal lesions mixed with hemorrhages along the superior vascular arcade. (B) Fundus photograph showing healed lesion and hemorrhages after intravitreal ganciclovir injection.
jkos-57-316f4.tif
Figure 5.
Fundus photographs of rignt eye in case 5 patient. (A) Fundus photograph showing multiple whitish retinal lesions and hemorrhage at peripheral retinal of all quadrants and peripheral laser markings after diagnostic vitrectomy. (B) Retinal lesions and hemorrhage was decreased after intravitreal ganciclovir injection.
jkos-57-316f5.tif
Table 1.
Clinical characteristics of cytomegalovirus retinitis patients
Patient Sex/ age (years) Underlying disease F/U (month) CMV PCR (+) Serum CMV specific IgG Enrolled eye Injection number VA before treatment (snellen) VA after final treatment (snellen) Complication
1 M/64 Thymoma, PRCA 12 (+) (+) OS 14 0.06 0.4 None
2 F/60 DLBCL 3 (+) OD 11 1.0 1.0 None
OS 11 0.3 0.1
3 M/48 AML 21 (+) OD 13 1.0 1.0 None
4 F/29 Dermatomyositis 8 (+) OD 12 0.3 0.8 None
5 F/47 Behcet's disease 7 (+) (+) OD 23 0.1 0.5 None

F/U = follow up; CMV = cytomegalovirus; PCR = polymerase chain reaction; IgG = immunoglobulin G; VA = visual acuity; PRCA = pure red cell aplasia; DLBCL = diffuse large B cell lymphoma; AML = acute myeloid leukemia.

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