LONG-TERM INTRAVITREAL GANCICLOVIR THERAPY FOR CYTOMEGALO-VIRUS RETINOPATHY
LONG-TERM INTRAVITREAL GANCICLOVIR THERAPY FOR CYTOMEGALO-VIRUS RETINOPATHY
复制标题
DOI：
10.1001/archopht.1989.01070020849025
复制
发表时间：
1989-12-01
影响因子：
--
通讯作者：
HEINEMANN, MH
中科院分区：
文献类型：
--
作者：
HEINEMANN, MH
前瞻性研究了玻璃体内注射更昔洛韦钠作为巨细胞病毒视网膜炎并发获得性免疫缺陷综合征的唯一治疗方法的安全性和有效性。除了一名患者外，所有患者都患有双侧巨细胞病毒性视网膜炎，由于6名患者出现骨髓抑制和1名患者出现肝毒性，所有患者都不能耐受全身应用更昔洛韦的治疗。玻璃体内注射更昔洛韦的两名患者在最初的两周诱导阶段内停止了治疗，原因是一名患者出现严重的顽固性血小板减少症，另一名患者出现视网膜脱离。视网膜脱离不能最终归因于注射，可能是巨细胞病毒视网膜炎的继发性并发症。其余5名患者每周接受治疗，疗程从最少14周(18次注射)到最多56周(58次注射)不等。平均随访23.5周。所有的眼睛最初对玻璃体内治疗有反应，而6只患有巨细胞病毒视网膜炎的未治疗的对照眼都显示出疾病的进展。两只眼睛在接受玻璃体内注射200微克更昔洛韦钠时复发，随后每次注射300微克更昔洛韦钠。一只眼睛对这种疗法有反应，而另一只眼睛病情恶化。长期治疗组1只眼发生葡萄球菌性眼内炎，行玻璃体切除联合玻璃体腔内及全身抗生素治疗。
The safety and efficacy of intravitreously administered ganciclovir sodium as sole treatment for cytomegalovirus retinitis complicating the acquired immunodeficiency syndrome was studied prospectively in seven patients. All but one of the patients had bilateral cytomegalovirus retinitis and none were able to tolerate therapy with systemically administered ganciclovir because of myelosuppression in six patients and hepatotoxicity in one patient. Intravitreal ganciclovir therapy was discontinued in two patients within the initial 2-week induction phase because of severe intractable thrombocytopenia in one patient and retinal detachment in the other. The retinal detachment could not be conclusively attributed to the injections and was probably a secondary complication of cytomegalovirus retinitis. The remaining five patients were treated weekly, with the course of therapy ranging from a minimum of 14 weeks (18 injections) to a maximum of 56 weeks (58 injections). The patients were followed up for an average of 23.5 weeks. All eyes responded to intravitreal therapy initially, while the six untreated control eyes with cytomegalovirus retinitis all demonstrated progression of disease. Two eyes relapsed while receiving intravitreal doses of 200 .mu.g of ganciclovir sodium and were subsequently treated with 300 .mu.g of ganciclovir sodium per injection. One eye responded to this regimen, while in the other one the disease progressed. In the long-term treatment group, one eye developed Staphylococcus epidermidis endophthalmitis, which was treated with vitrectomy and intravitreal and systemic antibiotics.