Abstract
Purpose :
To systematically review the published evidence on the efficacy and safety of the treatment modalities of cytomegalovirus (CMV) retinitis in human immunodeficiency virus seropositive patients, focusing on comparison between the visual and structural outcomes of intravitreal, oral, and intravenous anti-CMV therapy.
Methods :
A systematic literature search with no publication year or language restriction, of the PubMed, Medline, Scopus, Ovid and Cochrane databases, including ongoing research registered on Clinical trial.gov, was preformed until November 2018. Among articles about anti-CMV medications ganciclovir, foscarnet, cidofovir, fomivirsen, and valganciclovir, thirteen citations were included. All articles were rated into the levels of evidence according to the articles’ methodology.
Results :
Of the thirteen included articles, four randomized clinical trials were determined to be Level II evidence, supporting oral anti-CMV therapy using ganciclovir or valganciclovir as an induction and maintenance, compared to intravenous therapy in terms of visual, retinal structural and progression outcomes. Nine articles, case series and case reports (2 articles) were categorized as Level III evidence. One article supported the use of valganciclovir for maintenance therapy with untoward reactions similar to the intravenous agents. Five articles supported the use of intravitreal ganciclovir, which effectively improved visual and structural outcomes, although each article used different dose regimens. Three articles reported that foscarnet was an alternative treatment for ganciclovir-resistant patients.
Conclusions :
Available evidence indicates that oral valganciclovir is effective for initial and maintenance therapy of CMV retinitis. Intravenous ganciclovir is also effective but causes myelosuppression and neurologic dysfunction. Because of severe unwanted systemic effects and the high-cost of systemic therapy, intravitreal ganciclovir is reported to be advantageous for patients with sight-threatening disease, multiple underlying diseases who are unsuitable candidates for systemic therapy, or in developing and under-developed countries. Although Intravitreal ganciclovir can be alternatively used as definite treatment, the injection should be carefully performed to avoid recognized possible complications such as retinal detachment, endophthalmitis, and immune recovery uveitis.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.