Intravitreal therapy for CMV retinitis with standard and high dose foscarnet and ganciclovir

Purpose. A retrospective study of the efficacy and safety of intravitreal injections of ganciclovir or foscarnet for the treatment of active cytomegalovirus retinitis in patients with AIDS was performed. Methods. Thirty patients (44 eyes) with CMV retinitis were treated with various doses of intravitreal ganciclovir (1.5, 2.0, 2.5, or 4.0 mg) or foscarnet (1.2, 1.8, or 2 4 mg). Indications were myelosuppression, nephrotoxicity, and refusal of intravenous therapy. Average follow-up was 19.3 weeks. Results. At total of 978 injections were given. Intravitreal therapy halted the progression of CMV retinitis in 80% of eyes. 21 of 44 (45%) eyes had reactivation or progression of disease and necessitated change from one intravitreal regimen to another. Seventy percent of eyes maintained vision of 20/30 or better at last follow-up with 7 (16%) additional eyes maintaining vision between 20/40 and 20/80. Four eyes developed retinal detachments and one other eye a sterile endophthalmitis. Conclusions. Intravitreal therapy provides a safe and effective method of managing select cases of CMV retinitis in patients where systemic therapy has proven not to be efficacious in managing disease.