Abstract
Abstract: :
Purpose: Intraocular sustained release devices have been implanted since 1995 in patients with AIDS and CMV–retinitis. There are some reports about complications after implantation, like delayed extrusion of the ganciclovir device. We noticed within one year three patients under HAART (High Active Anti–Retroviral Therapy) with dropped sustained release ganciclovir devices which were implanted 5–6 years ago and all fixed with nylon sutures. Methods: Interventional case report of three patients complaining of a deterioration of visual acuity and a shadow in the eye. Examinations were performed by ophthalmoscopy to localize the dropped implant and OCT to detect macular edema. In all patients a pars–plana vitrectomy with a 5 mm scleral incision was performed to explant the ganciclovir device. Follow up time was 3–9 months (mean 6 months). Results: In all patients visual acuity recovered from 20/200 to 20/40 and 20/32 within months. All patients with HIV and CMV–retinitis suffered from a severe cystoid macular edema (CME) caused by the dropped intraocular sustained release device. The macular edema was treated by intraoperative intraocular injection of triamcinolone (4 mg), one patient needed two additional intravitreal injections of triamcinolone to recover one's sight. Conclusions: Intraocular sustained release devices must not be fixed anymore with recommended nylon sutures, because in the age of HAART survival time of the patients will be more than 10 years and so there is a demand of a non resorbable 8/0 polpropylene suture to fix the implant in the pars plana. Intravitreal Triamcinolone could be very helpful in the therapy of severe CME in patients with CMV–retinitis and HAART.
Keywords: AIDS/HIV • cytomegalovirus • macula/fovea