Cytomegaloviral retinitis was diagnosed in nine eyes of seven patients with
acquired immune deficiency syndrome (
AIDS) on the basis of the characteristic ocular findings and a positive culture for cytomegalovirus (CMV) obtained systemically. Treatment with
ganciclovir was begun on a protocol which provided two weeks of inpatient
therapy at daily doses of 2.5 to 10 mg/kg followed by outpatient
therapy at a reduced dosage three to six days per week. Outpatient maintenance dosage ranged from 15 mg/kg per week to 30 mg/kg per week. In seven eyes of six patients the treatment decreased
retinal inflammation and stabilised the margins of the lesions. Six patients have tolerated long term maintenance
therapy for 10-30 weeks. Six of seven patients (85%) in this study developed side effects from
ganciclovir which required periods of a reduction in dosage or interruption of
therapy. The side effects from
ganciclovir included
neutropenia,
thrombocytopenia,
drug fever, and neuropathy. Physicians using
ganciclovir in
AIDS patients must watch for the signs of
drug toxicity and adjust treatment accordingly.
Ganciclovir appears to be a promising
therapy for CMV
retinitis, but further work is necessary to determine the best regimen for optimal efficacy with minimal side effects.