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K. Oktavec, M. Yew, K. Nolan, J. P. Dunn, D. Brown, A. Livingston, J. E. Thorne; Clinical Outcomes in Patients With Cytomegalovirus Retinitis Treated With Ganciclovir Implant. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4854.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the clinical outcomes of patients with cytomegalovirus retinitis (CMVR) and AIDS treated with ganciclovir implants and to investigate associations between treatment and post-operative ocular complications.
Retrospective chart review of 115 patients (166 eyes) with CMVR treated with ganciclovir implant in the Division of Ocular Immunology, Wilmer Eye Institute from April 1996 through November 2009. Ophthalmological data were collected at baseline and during the follow up period included visual acuity, ocular complications, treatment, and presence of immune recovery. Kaplan-Meier analyses and Cox regression models were used to investigate relationships between potential risk factors and ocular outcomes.
The median age at CMVR diagnosis was 38 years. 64% of patients were men; 68% were African-American. The median duration of AIDS prior to CMVR diagnosis was 3.8 years. At implantation, 55% of patients were receiving highly active antiretroviral therapy (HAART), 13% were formerly on HAART, and 32% were HAART-naive. Over a median follow up of 1.2 years, 70 patients died (rate = 0.23/person-year [PY]). 166 eyes received 257 ganciclovir implants and were diagnosed with 124 ocular complications (rate = 0.32/eye-year [EY]), the 3 most common being cataract (0.07/EY), vitreous hemorrhage (0.06/EY), and retinal detachment (0.06/EY). Despite these complications, the development of severe vision loss (> 6 lines lost) was low (.005/EY). Presence of immune recovery was associated with improved survival and decreased ocular complication rates. Patients who underwent immune recovery during follow up were 13%, 34%, and 71% less likely to develop cataract, vitreous hemorrhage, or retinal detachment after implant surgery, respectively although only the risk reduction for retinal detachment achieved statistical significance (hazard ratio = 0.29, 95% CI: 0.08, 0.98).
Our data suggest that ocular complications, including cataract development, vitreous hemorrhage and retinal detachment are relatively common after ganciclovir implantation but severe vision loss after surgery is low. Presence of immune recovery may lessen the risk of post-operative ocular complications.
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