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JL Chua, TH Lim, G Chuah; Retrospective Comparison of the Efficacy of Low vs High Dose Intravitreal Ganciclovir in the Treatment of Cytomegalovirus Retinitis . Invest. Ophthalmol. Vis. Sci. 2002;43(13):4332.
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Purpose: Intravitreal ganciclovir has been shown to be an effective, safe and inexpensive local treatment of cytomegalovirus retinitis. In this study, we compare the efficacies of intravenous regimen vs low dose (0.4mg ganciclovir weekly) and high dose (2.0mg ganciclovir weekly) intravitreal regimens in HAART-naive patients. Methods: Three non-randomised groups of patients with cytomegalovirus retinitis (intravenous regimen, low dose intravitreal regimen and high dose intravitreal regimen) were followed up with indirect ophthalmoscopy aided by fundal photographs. The time to progression of retinitis was analysed retrospectively using Kaplan Meier survival analysis. Results: The mean time to progression of the intravenous group (17 eyes) were 79 days (95% CI: 53,106 days, follow up 28-214 days); that of low dose intravitreal group (10 eyes) was 214 days (95% CI: 145,284 days, follow up 27-290 days). None of the 13 eyes on high dose intravitreal regimen progressed (follow up 44-320 days). Asymptomatic, mild mid-periphery pigmentary retinopathy was observed in 3 patients in the high-dose intravitreal group. Conclusion: Both low and high dose intravitreal regimens offered better control of cytomegalovirus retinitis as compared to intravenous regimen. Although high dose treatment was highly effective, longterm safety of the high dose intravitreal regimen would require close monitoring.
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