Initial intravitreal injection of high-dose ganciclovir for cytomegalovirus retinitis in HIV-negative patients

Abstract

Background: The purpose of this study is to examine the clinical outcomes achieved by using initial high-dose intravitreal ganciclovir injections to treat cytomegalovirus retinitis in patients without human immunodeficiency virus (HIV) infection.

Methods: Twenty-four eyes (24 patients) with cytomegalovirus retinitis received multiple intravitreal injections of ganciclovir in weekly intervals. A higher dose (6 mg) of ganciclovir was applied at the first intravitreal injection, and a lower dose was used for maintenance. Anterior aqueous humour was obtained before each injection. The best-corrected visual acuity and cytomegalovirus loads in the anterior aqueous humour were measured.

Results: The mean cytomegalovirus DNA load in aqueous humour decreased significantly from (2.59 ± 2.28) × 105 copies/mL at baseline to (1 ± 1.76) × 104 copies/mL one month later. The aqueous cytomegalovirus DNA load was negative in 17 eyes (70.8%) one month later. No obvious improvement of best-corrected visual acuity was found during the treatment. A positive correlation was proven between initial cytomegalovirus DNA titers in aqueous humour and the total number of intravitreal injections of ganciclovir, as well as between the baseline and final best-corrected visual acuities. No severe complications developed.

Conclusions: An initial high dose of ganciclovir (6 mg) and continuous intravitreal injections of ganciclovir could significantly decrease the cytomegalovirus load in HIV-negative patients with cytomegalovirus retinitis.

Trial registration: https://ichgcp.net/clinical-trials-registry/NCT03598452" title="See in ClinicalTrials.gov">NCT03598452, retrospectively registered on 24 July 2018.

Keywords: Aqueous humour; Cytomegalovirus retinitis; Ganciclovir; High-dose; Intravitreal injection.

Conflict of interest statement

Ethics approval and consent to participate

The ethics committees of the Beijing Capital Medical University and Beijing Chaoyang Hospital approved this study, and informed consent was obtained from all patients.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1

CMV DNA titer in aqueous humour of patients with CMVR during first four IVG once a week. CMV load decreased continuously during the procedure

Fig. 2

Regression analysis for total number of IVG and final BCVA. (a) Positive correlation between initial CMV DNA tiers in aqueous humour and total number of IVG (R2 = 0. 772, P = 0.000). (b) Positive correlation between baseline BCVA and final BCVA (R2 = 0.762,P = 0.000)

Fig. 3

A case of ineffective intravitreal ganciclovir. a The active lesion and haemorrhage located in the nasal quadrant of retina. b After third IVG, the lesion size decreased with CMV DNA load in aqueous humour reduction. c After fourth IVG, the lesion size enlarged towards the posterior pole, and CMV DNA load in aqueous humour increased. d Intravitreal ganciclovir was replaced by foscarnet. After three injections, the lesion became inactive, and CMV DNA load in aqueous humour turned negative