Comparison of intravitreal ganciclovir monotherapy and combination with foscarnet as initial therapy for cytomegalovirus retinitis
Comparison of intravitreal ganciclovir monotherapy and combination with foscarnet as initial therapy for cytomegalovirus retinitis
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DOI：
10.18240/ijo.2018.10.10
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发表时间：
2018-10-18
影响因子：
1.4
通讯作者：
Hwang, De-Kuang
中科院分区：
文献类型：
--
作者：
Fan, Jing-Jing;Tao, Yong;Hwang, De-Kuang
目的：比较更昔洛韦单用与氟膦酸钠联合多次玻璃体内注射治疗新发巨细胞病毒性视网膜炎（CMVR）的疗效。方法：回顾性研究2013 - 2015年间发生CMVR的患者37例（58只眼）。其中35只眼每4周玻璃体内注射3.0 mg更昔洛韦，23只眼每4周注射3.0 mg更昔洛韦联合2.4 mg磷磷。采用实时聚合酶链反应法测定每次注射前后房水中巨细胞病毒（CMV）载量、眼压和视力。结果：两组房水CMV-DNA拷贝数均显著减少。更昔洛韦单药组患者的CMV-DNA拷贝数从基线时的38.3x10(4)拷贝/mL降至第4次注射后的2.2x10(4)拷贝/mL；更昔洛韦联合氟糖净连续注射4次后的CMV-DNA拷贝数从76.9x10(4)拷贝/mL降至11.3x10(4)拷贝/mL。单药治疗和联合治疗在降低病毒载量、改变视力和眼压方面无显著差异。结论：本研究结果显示，4周玻璃体内注射治疗CMVR的初始有效性与单用更昔洛韦或联用氟膦酸钠无显著差异。持续单独注射更昔洛韦足以治疗新发CMVR免疫抑制患者。
AIM: To compare the effectiveness between multiple intravitreal injections of ganciclovir alone and combined with foscarnet as initial treatment for patients with newly-onset cytomegalovirus retinitis (CMVR).METHODS: The retrospective study observed 37 patients (58 eyes) who suffered from CMVR onset between 2013 and 2015. Among them, 35 eyes underwent 4 weekly intravitreal injections of 3.0 mg ganciclovir, and 23 eyes underwent 4 weekly injections of 3.0 mg ganciclovir combined with 2.4 mg foscarnet. Visual acuity, intraocular pressure and viral load of cytomegalovirus (CMV) in aqueous humor measured by real-time polymerase chain reaction were compared before and after each injection.RESULTS: CMV-DNA copies in aqueous humor decreased remarkably in both groups. The average of CMV-DNA copies in patients' aqueous decreased from 38.3x10(4) copies/mL at baseline to 2.2x10(4) copies/mL after the 4th injection in patients who were treated with ganciclovir monotherapy, and decreased from 76.9x10(4) copies/mL to 11.3x10(4) copies/mL after 4 continuous injections of ganciclovir combined with foscarnet. No significant difference was found in reduction of viral load, change of visual acuities or intraocular pressures between monotherapy or combined therapy.CONCLUSION: Results of this study show that the initial effectiveness of treating CMVR after 4 weekly intravitreal injections is not significantly different from ganciclovir alone or combined with foscarnet. Continuous injection of ganciclovir alone is sufficient in treating immunosuppressive patients with newly-onset CMVR.