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Graefe's Archive for Clinical and Experimental Ophthalmology

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01-09-2014 | Retinal Disorders

Outcome of cytomegalovirus retinitis in immunocompromised patients without Human Immunodeficiency Virus treated with intravitreal ganciclovir injection

Authors: Aniruddha Agarwal, Neha Kumari, Amita Trehan, Alka Khadwal, Mangat R. Dogra, Vishali Gupta, Aman Sharma, Amod Gupta, Ramandeep Singh

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology | Issue 9/2014

Abstract

Purpose

To study the outcomes of treatment with intravitreal ganciclovir injection for cytomegalovirus (CMV) retinitis in patients without Human Immunodeficiency Virus (HIV) infection.

Methods

In this retrospective cohort study, demographic and clinical characteristics of patients with CMV retinitis without HIV were noted. Patients received intravitreal ganciclovir injection (2 mg/0.1 ml) alone until quiescence. The outcome measures were time taken for the lesions to heal, number of injections, change in best-corrected visual acuity (BCVA), recurrence of retinitis, occurrence of immune recovery uveitis (IRU) or injection-related complications and retinal detachment (RD).

Results

18 eyes of ten patients (six males) with mean age of 33.7 years from June 2004 to March 2013 were included. Thirteen eyes with active lesions (mean BCVA of 0.51 ± 0.41) received 5.54 ± 3.36 intravitreal ganciclovir injections with complete healing within 1.81 ± 1.25 months. The final BCVA was 0.43 ± 0.52. IRU was observed in six eyes (33.33 %) and RD developed in one eye. One eye had recurrence 1 month after stopping ganciclovir injections. The rest of the patients had recurrence-free follow-up at 9.46 ± 12.42 months.

Conclusions

Non-HIV patients with CMV retinitis can be successfully treated with intravitreal ganciclovir injection alone, avoiding the systemic side effects of systemic anti-CMV therapy.

Hoover DR, Peng Y, Saah A, Semba R, Detels RR, Rinaldo CR Jr, Phair JP (1996) Occurrence of cytomegalovirus retinitis after human immunodeficiency virus immunosuppression. Arch Ophthalmol 114:821–827PubMedCrossRef

Jabs DA (1995) Ocular manifestations of HIV infection. Trans Am Ophthalmol Soc 93:623–683PubMedCentralPubMed

Fiala M, Payne JE, Berne TV, Moore TC, Henle W, Montgomerie JZ, Chatterjee SN, Guze LB (1975) Epidemiology of cytomegalovirus infection after transplantation and immunosuppression. J Infect Dis 132:421–433PubMedCrossRef

Coskuncan NM, Jabs DA, Dunn JP, Haller JA, Green WR, Vogelsang GB, Santos GW (1994) The eye in bone marrow transplantation: VI. Retinal complications. Arch Ophthalmol 112:1372–1379CrossRef

Pathanapitoon K, Tesavibul N, Choopong P, Boonsopon S, Kongyai N, Ausayakhun S, Kunavisarut P, Rothova A (2013) Clinical manifestations of cytomegalovirus-associated posterior uveitis and panuveitis in patients without Human Immunodeficiency Virus infection. JAMA Ophthalmol 131:638–645PubMedCrossRef

Bertelmann E, Liekfeld A, Pleyer U, Hartmann C (2005) Cytomegalovirus retinitis in Wegener’s granulomatosis: case report and review of the literature. Acta Ophthalmol Scand 83:258–261PubMedCrossRef

Langner-Wegscheider BJ, ten Dam-van Loon N, Mura M, Faridpooya K, de Smet MD (2010) Intravitreal ganciclovir in the management of non-AIDS-related human cytomegalovirus retinitis. Can J Ophthalmol 45:157–160PubMedCrossRef

Cho WB, Kim HC, Moon JW (2012) Spontaneous resolution of intravitreal steroid-induced bilateral cytomegalovirus retinitis. Korean J Ophthalmol 26:151–155PubMedCentralPubMedCrossRef

Saidel MA, Berreen J, Margolis TP (2005) Cytomegalovirus retinitis after intravitreous triamcinolone in an immunocompetent patient. Am J Ophthalmol 140:1141–1143PubMedCrossRef

10.

Ufret-Vincenty RL, Singh RP, Lowder CY, Kaiser PK (2007) Cytomegalovirus retinitis after fluocinolone acetonide (Retisert) implant. Am J Ophthalmol 143:334–335PubMedCrossRef

11.

Kuo IC, Kempen JH, Dunn JP, Vogelsang G, Jabs DA (2004) Clinical characteristics and outcomes of cytomegalovirus retinitis in persons without human immunodeficiency virus infection. Am J Ophthalmol 138:338–346PubMedCrossRef

12.

Jabs DA, Bolton SG, Dunn JP, Palestine AG (1998) Discontinuing anticytomegalovirus therapy in patients with immune reconstitution after combination antiretroviral therapy. Am J Ophthalmol 126:817–822PubMedCrossRef

13.

Spector SA, Weingeist T, Pollard RB et al (1993) A randomized controlled study of intravenous ganciclovir therapy for cytomegalovirus peripheral retinitis in patients with AIDS. J Infect Dis 168:557–563PubMedCrossRef

14.

Studies of Ocular Complications of AIDS Research Group in Collaboration with the AIDS Clinical Trials Group (1997) Parenteral Cidofovir for Cytomegalovirus Retinitis in Patients with AIDS: The HPMPC Peripheral Cytomegalovirus Retinitis Trial. Ann Intern Med 126:264–274CrossRef

15.

Studies of Ocular Complications of AIDS Research Group, in collaboration with the AIDS Clinical Trials Group (1992) Mortality in patients with the acquired immunodeficiency syndrome treated with either foscarnet or ganciclovir for cytomegalovirus retinitis. N Engl J Med 326:213–220CrossRef

16.

Studies of Ocular Complications of AIDS Research Group (1995) Morbidity and toxic effects associated with ganciclovir or foscarnet therapy in a randomized cytomegalovirus retinitis trial. Studies of the Ocular Complications of AIDS Research Group, in collaboration with the AIDS Clinical Trials Group. Arch Intern Med 155:65–74CrossRef

17.

Griffy KG (1996) Pharmacokinetics of oral ganciclovir capsules in HIV-infected persons. AIDS 10:3–6

18.

Lalezari JP, Friedberg DN, Bissett J et al (2002) High dose oral ganciclovir treatment for cytomegalovirus retinitis. J Clin Virol 24:67–77PubMedCrossRef

19.

Musch DC, Martin DF, Gordon JF et al (1997) Treatment of cytomegalovirus retinitis with a sustained-release ganciclovir implant. The Ganciclovir Implant Study Group. N Engl J Med 337:83–90PubMedCrossRef

20.

Young S, Morlet N, Besen G, Wiley CA, Jones P, Gold J, Li Y, Freedman WR, Coroneo MT (1998) High-dose (2000-μg) intravitreous ganciclovir in the treatment of cytomegalovirus retinitis. Ophthalmology 105:1404–1410PubMedCrossRef

21.

Visser L (2003) Managing CMV retinitis in the developing world. Community Eye Health 16:38–39PubMedCentralPubMed

22.

Gupta S, Vemulakonda GA, Suhler EB, Yeh S, Albini TS, Mandelcorn E, Flaxel CJ (2013) Cytomegalovirus retinitis in the absence of AIDS. Can J Ophthalmol 48:126–129PubMedCrossRef

23.

Tugal-Tutkun I, Araz B, Cagatay A (2010) CMV retinitis after intravitreal triamcinolone acetonide injection in a patient with Behçet’s uveitis. Int Ophthalmol 30:591–593PubMedCrossRef

24.

Kelkar A, Kelkar J, Kelkar S, Bhirud S, Biswas J (2011) Cytomegalovirus retinitis in a seronegative patient with systemic lupus erythematosus on immunosuppressive therapy. J Ophthal Inflamm Infect 1:129–132CrossRef

25.

Baumal CR, Levin AV, Read SE (1999) Cytomegalovirus retinitis in immunosuppressed children. Am J Ophthalmol 127:550–558PubMedCrossRef

26.

Mitchell CD, Richards SM, Kinsey SE, Lilleyman J, Vora A, Eden TO (2005) Benefit of dexamethasone compared with prednisolone for childhood acute lymphoblastic leukaemia: results of the UK Medical Research Council ALL97 randomized trial. Br J Haematol 129:734–745PubMedCrossRef

27.

Jabs DA (2011) Cytomegalovirus retinitis and the acquired immunodeficiency syndrome-bench to bedside: LXVII Edward Jackson Memorial Lecture. Am J Ophthalmol 151:198–216PubMedCentralPubMedCrossRef

28.

Komanduri KV, Viswathanan MN, Wieder ED, Schmidt DK, Bredt BM, Jacobson MA, McCune JM (1998) Restoration of cytomegalovirus specific CD4+ T lymphocyte responses after ganciclovir and highly active antiretroviral therapy in individuals infected with HIV-1. Nat Med 4:953–956PubMedCrossRef

29.

Toriyama K, Suzuki T, Hara Y, Ohashi Y (2012) Cytomegalovirus retinitis after multiple ocular surgeries in an immunocompetent patient. Case Rep Ophthalmol 3:356–359PubMedCentralPubMedCrossRef

30.

Taha R, Al Hijji I, El Omri H, Al-Laftah F, Negm R, Yassin M, El Ayoubi H (2010) Two Ocular Infections during Conventional Chemotherapy in a Patient with Acute Lymphoblastic Leukemia: A Case Report. Case Rep Oncol 3:234–239PubMedCentralPubMedCrossRef

31.

Park YS, Byeon SH (2008) Cytomegalovirus retinitis after intravitreous triamcinolone injection in a patient with central retinal vein occlusion. Korean J Ophthalmol 22:143–144PubMedCentralPubMedCrossRef

32.

Singh R, Singh R, Trehan A, Jain R, Bhalekar S (2013) Cytomegalovirus retinitis in an ALL child on exclusive chemotherapy treated successfully with intravitreal ganciclovir alone. J Pediatr Hematol Oncol 35:e118–e119PubMedCrossRef

Title: Outcome of cytomegalovirus retinitis in immunocompromised patients without Human Immunodeficiency Virus treated with intravitreal ganciclovir injection
Authors: Aniruddha Agarwal
Neha Kumari
Amita Trehan
Alka Khadwal
Mangat R. Dogra
Vishali Gupta
Aman Sharma
Amod Gupta
Ramandeep Singh
Publication date: 01-09-2014
Publisher: Springer Berlin Heidelberg
Published in: Graefe's Archive for Clinical and Experimental Ophthalmology / Issue 9/2014
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI: https://doi.org/10.1007/s00417-014-2587-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Outcome of cytomegalovirus retinitis in immunocompromised patients without Human Immunodeficiency Virus treated with intravitreal ganciclovir injection

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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