Purpose: To study high intravitreal dosage of ganciclovir (2000 or 4000 micrograms) in acquired immunodeficiency syndrome (AIDS) and cytomegalovirus retinitis. Methods: Prospective study for high dose intravitreal ganciclovir (2000 or 4000 micrograms) between 1996 and 1998 at the Federal University of São Paulo - Paulista Medical School in patients with diagnosis of AIDS, herpetic cytomegalovirus and intolerance to intravenous or oral treatment. Results: Of 1950 patients examined, 21 (1.07%) were intolerant to systemic treatment (ganciclovir or foscarnet). Of those, 21 with 37.1 years average age, corresponding to 31 eyes were treated with intravitreous medication. Seventeen patients (81%) were male. Of the 21 patients, 11 (14 eyes) received 2000 µg intravitreous medication and 10 (17 eyes) received 4000 µg. In the beginning of the treatment 100% of the patients showed low vision. At the end of the treatment (22 weeks on average), group I (intravitreous medication 2000 µg) showed increase of visual acuity (VA) in 35.7%, the same VA in 50% and decrease of VA in 14.3% due to retinal detachment. In the group II (intravitreous medication 4000 µg) 58.8% had increased VA, 23.5% had the same VA and 17.6% had decrease of VA due to cataract and retinal detachment. Conclusions: Intravitreous injection of a high dose (2000 or 4000 micrograms/0,1 ml) of ganciclovir for the treatment of a CMV retinitis is satisfactory. The adverse effects are cataract and retinal detachment. The retinal detachment could not be conclusively attributed to the injections and was probably a secondary complication of cytomegalovirus retinitis.
Acquired immunodeficiency syndrome; Cytomegalovirus retinitis; Ganciclovir; Injections; Vitreous body; Prospective studies
