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Intraocular therapy for cytomegalovirus retinitis.


 Cytomegalovirus (CMV) retinitis, a sight-threatening infection common in AIDS patients, can be treated systemically with intravenous ganciclovir, intravenous foscarnet, or oral ganciclovir. These treatments are subject to resistance and become less effective with time. A retinal detachment also occurs in 25 percent to 30 percent of patients with the condition. Intravitreal treatment for CMV retinitis is increasingly effective. It does not have the disadvantage of systemic toxicity, and it allows higher drug levels to be delivered to the retina. A disadvantage is that it does not treat the infection throughout the body. Eye diseases are often treated locally with topical agents because they are isolated, but CMV retinitis cannot be treated topically. Local treatment for CMV involves direct delivery of the drug into the vitreous so it can diffuse into the retina, where CMV replicates. Intravitreal CMV therapy can be delivered either through ganciclovir implantation, ganciclovir injection, foscarnet injection, cidofovir injection, or Isis 2922 injection. Each option has its advantages and disadvantages, and using more than one of the treatments may be necessary over the course of infection.
