Multiple intravitreal injections of ganciclovir for cytomegalovirus retinitis after stem-cell transplantation
Multiple intravitreal injections of ganciclovir for cytomegalovirus retinitis after stem-cell transplantation
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DOI：
10.1007/s00417-013-2368-6
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发表时间：
2013-07-01
影响因子：
2.7
通讯作者：
Li, Xiao-xin
中科院分区：
文献类型：
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作者：
Miao, Heng;Tao, Yong;Li, Xiao-xin
巨细胞病毒（CMV）感染是造血干细胞移植（HSCT）后患者发病和死亡的主要原因。尽管在治疗继发于获得性免疫缺陷综合征（AIDS）的巨细胞病毒性视网膜炎方面已经付出了很多努力，但已发表的少数报道主要集中在HSCT后巨细胞病毒性视网膜炎的治疗上。本临床介入回顾性研究纳入14例干细胞移植后CMV视网膜炎患者（男性8例，平均年龄23.89 +/- 12.09；23只眼），目的是评价多次玻璃体内注射更昔洛韦（IVG）治疗CMV视网膜炎的疗效和安全性。所有患者每隔1周注射4次IVG，剂量为1mg，每周随访至少2个月，实时聚合酶链反应测量最佳矫正视力（BCVA）和前房水CMV水平。每次注射前取前房水。前房水CMV水平从基线时的（6.34 +/- 15.78）× 10(5)拷贝/ml显著下降到1个月时的（5.22 +/- 12.15）× 10(3)拷贝/ml （P < 0.001， Mann-Whitney U检验）。两次注射后，11只眼（47.8%）无法检测到CMV， 1个月后，这一数字上升到18只眼（78.3%）。基线时的平均logMAR BCVA为0.659 +/- 0.572,2个月时为0.680 +/- 0.527，表明手术期间无显著改善（P = 0.736， Mann-Whitney U检验）。4次IVG注射后，所有患者玻璃体混浊改善，眼底镜下病变面积缩小。无严重并发症发生。多次IVG似乎对干细胞移植后巨细胞病毒性视网膜炎患者有益，可降低房水中巨细胞病毒性水平。为了获得更好的治疗效果，需要进一步研究更昔洛韦的最佳剂量。
Cytomegalovirus (CMV) infection is a major cause of morbidity and mortality in patients after hematopoietic stem cell transplantation (HSCT). Although much effort has been put into dealing with CMV retinitis secondary to acquired immunodeficiency syndrome (AIDS), the few reports which have been published have mainly focused on treatment of CMVR after HSCT.This clinical interventional retrospective study included 14 patients (eight men; mean age 23.89 +/- 12.09; 23 eyes) who suffered from CMV retinitis after stem-cell transplantation, in order to evaluate the efficacy and safety of multiple intravitreal injections of ganciclovir (IVG) for patients with CMV retinitis. All patients received 4 injections of IVG of 1 mg at 1 week intervals, and were followed up weekly for at least 2 months with measurement of best-corrected visual acuity (BCVA) and CMV levels in anterior aqueous humor with real-time polymerase chain reaction. Anterior aqueous humor was obtained before each injection.The levels of CMV in anterior aqueous humor showed significant decrease from (6.34 +/- 15.78) x 10(5) copies/ml at baseline to (5.22 +/- 12.15) x 10(3) copies/ml at 1 month (P < 0.001, Mann-Whitney U test). CMV couldn't be detected in 11 eyes (47.8 %) after two injections, and this rose to 18 eyes (78.3 %) at 1 month. The mean logMAR BCVA was 0.659 +/- 0.572 at baseline and 0.680 +/- 0.527 at 2 months, which suggested no significant improvement (P = 0.736, Mann-Whitney U test) during the procedure. All patients experienced improved vitreous opacity and diminished area of the lesion under funduscopy after 4 injections of IVG. No severe complications developed.Multiple IVG seemed to be beneficial for patients with CMV retinitis after stem-cell transplantation, in reducing CMV levels in aqueous humor. Further study to optimize the dose of ganciclovir is needed in order to achieve better treatment outcomes.