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C. H. Metz; CMV-Retinitis: A Review of Treatment Procedures Between 1996 and 2009. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5885.
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We compared different treatments of CMV-retinitis in immunocompromised, immunocompetent and human immunodeficiency virus infected individuals.
In a non-randomised, retrospective, interventional, non-comparative case series patients diagnosed with CMV-retinitis, either clinically or by biopsy, were reviewed. Between 1996 and 2009 a cohort of 7 patients/9 eyes received intravitreal ganciclovir injections (3mg/0.1ml) and 8 patients/ 10 eyes received a ganciclovir implant. In some cases diagnostic vitreous biopsy for polymerase chain reaction against CMV, VZV and HSV was performed. In most cases an intraveneous/oral therapy with either ganciclovir or forscanet was given additionally.
Follow-up time ranged between 3 months and 124 months (mean 20.47 months). An average number of 6.6 injections of ganciclovir (between 2 and 28) were necessary to treat the CMV-retinitis. The mean visual acuity dropped by 8 lines from logmar 0.54 to logmar 1.3056 at final visit. In the injection group four of nine eyes showed retinal detachment in the course of the disease and was treated by vitrectomy and two eyes developed amaurosis.None of ten eyes of the ganciclovir implant group showed retinal detachment, but one of ten eyes needed to be treated due to vitreous bleeding, one of ten eyes had to be enucleated and one out of ten eyes were operated due to macular pucker. Two out of ten eyes developed an amaurosis. In the group of patients treated with ganciclovir implants only one patient needed more than one implant. Mean visual acuity dropped by 8 lines from logmar 0,34 to logmar 1,1 at final visit.
CMV-retinitis is a devastating disease for the eye. Just in two cases, one in the implant group and one in the injection group, visual acuity could be improved. No treatment procedure showed more favourable results than the other. The main complication in this disease is a retinal detachment. We advise prompt diagnoses and treatment of the disease and frequent controls even after inflammation has stopped.
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