Clinical Outcomes in Patients With Cytomegalovirus Retinitis Treated With Ganciclovir Implant

• Published in: American journal of ophthalmology 2012-04, Vol.153 (4), p.728-733.e2
• Main Authors: Oktavec, Kathleen C, Nolan, Kisten, Brown, Diane M, Dunn, James P, Livingston, Alison G, Thorne, Jennifer E
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; AIDS-Related Opportunistic Infections - drug therapy; AIDS-Related Opportunistic Infections - immunology; Antiretroviral Therapy, Highly Active; Antiviral Agents - administration & dosage; Biological and medical sciences; Cataract - etiology; CD4 Lymphocyte Count; CD4-Positive T-Lymphocytes - immunology; Clinical outcomes; Cytomegalovirus Retinitis - drug therapy; Cytomegalovirus Retinitis - immunology; Drug Implants; Female; Ganciclovir - administration & dosage; HIV; Human immunodeficiency virus; Human viral diseases; Humans; Infectious diseases; Male; Medical research; Medical sciences; Middle Aged; Miscellaneous; Ophthalmology; Postoperative Complications; Postoperative period; Retinal Detachment - etiology; Retrospective Studies; Treatment Outcome; Urban Population; Viral diseases; Viral diseases with cutaneous or mucosal lesions and viral diseases of the eye; Vitreous Hemorrhage - etiology; Young Adult
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2011.09.010

Purpose To describe the clinical outcomes of patients with cytomegalovirus (CMV) retinitis and AIDS treated with ganciclovir implant. Design Retrospective cohort study. Methods The charts of 115 patients (166 affected eyes) with CMV retinitis treated with ganciclovir implant in the Division of Ocular Immunology, Wilmer Eye Institute from April 1996 through November 2009 were reviewed. Ophthalmologic data collected 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. Results At implantation, 55% of patients were prescribed highly active antiretroviral therapy (HAART), 21% were formerly on HAART, and 24% were HAART-naïve. One hundred sixty-six eyes received 257 ganciclovir implants. Fifty-seven of the implanted eyes were diagnosed with a total of 126 ocular complications after implant surgery (rate = 0.19/eye-year [EY]), the 3 most common being cataract, vitreous hemorrhage, and retinal detachment. Despite these ocular complications, the development of severe vision loss (≥6 lines lost) was low (0.005/EY). Patients with immune recovery during follow-up were less likely to have ocular complications after implant surgery; however, only the risk reduction for retinal detachment achieved statistical significance (hazard ratio = 0.29, 95% CI: 0.08, 0.98). Conclusions Our data suggest that ocular complications after implant surgery, including cataract, vitreous hemorrhage, and retinal detachment, were relatively common after ganciclovir implantation but severe vision loss after surgery was low. Presence of immune recovery may lessen the risk of postoperative ocular complications.