J Korean Ophthalmol Soc.  2013 Jun;54(6):977-981. 10.3341/jkos.2013.54.6.977.

Two Cases of Intravitreal Ganciclovir Injection for Cytomegalovirus Retinitis

Affiliations
  • 1Department of Ophthalmology, KyungHee University Medical Center, KyungHee University School of Medicine, Seoul, Korea. hwkwak@khu.ac.kr

Abstract

PURPOSE
To report 2 cases of cytomegalovirus retinitis treated with intravitreal ganciclovir.
CASE SUMMARY
A 29-year-old female (Case 1) who received immunosuppressive therapy with tacrolimus and mycophenolate mofetil for 3 months after pancreatic transplantation, was given an intravitreal Bevacizumab injection 4 times in each eye under the suspicion of bilateral central retinal vein occlusion. During follow-up, a new lesion with white opacification and multiple snowballs appeared in the left eye. Suspecting cytomegalovirus retinitis, we administered an intravitreal ganciclovir injection resulting in a decrease of white opacification and improvement of visual acuity. A 66-year-old male (Case 2) who was receiving treatment for general weakness and heart failure, presented with visual disturbance in both eyes. Fundoscopic examination revealed white opacification, multiple snowballs and retinal hemorrhage in the left eye; diagnostic vitrectomy was performed. Macular edema and subretinal fluid continued after the vitrectomy and the serologic testing revealed an IgG titer positive for cytomegalovirus, therefore, an intravitreal injection of ganciclovir was given. Macular edema and subretinal fluid decreased and visual acuity improved.
CONCLUSIONS
Intravitreal ganciclovir can be an effective treatment option for the management of CMV retinitis.

Keyword

Cytomegalovirus retinitis; Ganciclovir; Intravitreal ganciclovir injection

MeSH Terms

Antibodies, Monoclonal, Humanized
Cytomegalovirus
Cytomegalovirus Retinitis
Eye
Female
Follow-Up Studies
Ganciclovir
Heart Failure
Humans
Immunoglobulin G
Intravitreal Injections
Macular Edema
Male
Mycophenolic Acid
Retinal Hemorrhage
Retinal Vein
Retinitis
Serologic Tests
Subretinal Fluid
Tacrolimus
Transplants
Visual Acuity
Vitrectomy
Bevacizumab
Antibodies, Monoclonal, Humanized
Ganciclovir
Immunoglobulin G
Mycophenolic Acid
Tacrolimus

Figure

  • Figure 1. Fundus photographs & OCT of both eyes in case 1. (A) Fundus photograph of the left eye shows opaque white lesions at the inferonasal retina. (B) Fundus photograph of the left eye shows disappearance of opaque white lesions. (C) OCT of left eye shows residual macular edema. (D) OCT of left eye shows residual macular edema.

  • Figure 2. Fundus photographs & OCT of both eyes in case 2. (A) Fundus photograph of right eye shows retinal hemorrhage with opaque white lesions in inferior region of the optic disc and atrophic lesions at the temporal region. (B) Fundus photo-graph of the right eye shows improvement of retinal hemorrhage with opaque white lesions. (C) OCT of the right eye shows macular edema and submacular fluid. (D) OCT of the right eye shows no macular edema and submacular fluid.


Reference

References

1. Shahnaz S, Choksi MT, Tan IJ. Bilateral cytomegalovirus retinitis in a patient with systemic lupus erythematosus and end-stage renal disease. Mayo Clin Proc. 2003; 78:1412–5.
Article
2. Diamond C, Thiede H, Perdue T. . Seroepidemiology of human herpesvirus 8 among young men who have sex with men. Sex Transm Dis. 2001; 28:176–83.
Article
3. Drew WL, Mintz L, Miner RC. . Prevalence of cytomegalovi-rus infection in homosexual men. J Infect Dis. 1981; 143:188–92.
Article
4. Gallant JE, Moore RD, Richman DD. . Incidence and natural history of cytomegalovirus disease in patients with advanced hu-man immunodeficiency virus disease treated with zidovudine. The Zidovudine Epidemiology Study Group. J Infect Dis. 1992; 166:1223–7.
Article
5. Evans BG. Management of blinding disease: loss of immunity and superinfection. Eye (Lond). 2005; 19:1035–6.
Article
6. Stewart MW. Optimal management of cytomegalovirus retinitis in patients with AIDS. Clin Ophthalmol. 2010; 4:285–99.
Article
7. Langner-Wegscheider BJ, ten Dam-van Loon N, Mura M. . Intravitreal ganciclovir in the management of non-AIDS-related human cytomegalovirus retinitis. Can J Ophthalmol. 2010; 45:157–60.
Article
8. Ausayakhun S, Keenan JD, Ausayakhun S. . Clinical features of newly diagnosed cytomegalovirus retinitis in northern Thailand. Am J Ophthalmol. 2012; 153:923–31.
Article
9. Kabata Y, Takahashi G, Tsuneoka H. Cytomegalovirus retinitis treated with valganciclovir in Wegener's granulomatosis. Clin Ophthalmol. 2012; 6:521–3.
10. Faulds D, Heel RC. Ganciclovir. A review of its antiviral activity, pharmacokinetic properties and therapeutic efficacy in cytomega-lovirus infections. Drugs. 1990; 39:597–638.
Article
11. Huynh N, Daniels AB, Kohanim S, Young LH. Medical treatment for cytomegalovirus retinitis. Int Ophthalmol Clin. 2011; 51:93–103.
Article
12. Teoh SC, Ou X, Lim TH. Intravitreal ganciclovir maintenance in-jection for cytomegalovirus retinitis: efficacy of a low-volume, in-termediate-dose regimen. Ophthalmology. 2012; 119:588–95.
Article
13. Pulido J, Peyman GA, Lesar T, Vernot J. Intravitreal toxicity of hy-droxyacyclovir (BW-B759U), a new antiviral agent. Arch Ophthalmol. 1985; 103:840–1.
Article
14. Henry K, Cantrill H, Fletcher C. . Use of intravitreal ganciclovir (dihydroxy propoxymethyl guanine) for cytomegalovirus reti-nitis in a patient with AIDS. Am J Ophthalmol. 1987; 103:17–23.
Article
15. Harris ML, Mathalone MB. Intravitreal ganciclovir in CMV reti-nitis: case report. Br J Ophthalmol. 1989; 73:382–4.
Article
16. Young SH, Morlet N, Heery S. . High dose intravitreal ganci-clovir in the treatment of cytomegalovirus retinitis. Med J Aust. 1992; 157:370–3.
Article
17. Cochereau-Massin I, Lehoang P, Lautier-Frau M. . Efficacy and tolerance of intravitreal ganciclovir in cytomegalovirus reti-nitis in acquired immune deficiency syndrome. Ophthalmology. 1991; 98:1348–53.
Article
Full Text Links
  • JKOS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr