Nine patients with unilateral cytomegalovirus (CMV)
retinitis were treated with
intravenous infusions of the new virustatic
drug DHPG (
Ganciclovir). The induction dose was 10 mg/kg
body weight per day (2-5 weeks). In six cases, a maintenance dose was given thereafter of 5 mg/kg
body weight per day. After the induction dose, five patients had visual improvement and satisfactory
cicatrization. In one patient, PVR (proliferative vitreous reaction) developed with total tractional
retinal detachment. More ocular complications were seen while on longterm
therapy: relapses during discontinuation because of
leukopenia (three times in two patients), breakthrough (= relapse during maintenance
therapy) (one case), serous
retinal detachment (one case), and
optic atrophy (two cases). The complications caused
blindness in two further patients. Only one patient has tolerated maintenance
therapy for 22 weeks without having any complications. One patient wanted to have
therapy suspended and has remained free of relapse for 28 weeks while on
cytostatic therapy. The eyes of two deceased patients were examined histopathologically, immunhistochemically, and ultrastructurally and the findings compared with those of an untreated case. Given at an early stage and without discontinuation,
DHPG is an effective means of preventing or delaying
blindness caused by
cytomegalovirus retinitis in
AIDS patients. The directives for an optimal dosage are subject to further prospective randomized clinical studies.