97th DOG Annual Meeting 1999
COMPLICATED AIDS RELATED CMV RETINITIS AND GANCICLOVIR IMPLANTS
H. Häberle1, P. Kaulen2, C. Wiemer2, D. T. Pham1
Introduction: Due to improved antiretroviral therapies today patients with aids and CMV retinitis survive longer and with better general health. We report about 10 patients with ganciclovir implant for complicated CMV retinitis.
Patients and Methods: Since August 1997, 10 patients (aged 41.9 years) with complicated CMV retinitis underwent ganciclovir implantation or exchange or pars plana vitrectomy (PPV) with silicone oil tamponade for tractive retinal detachment. Maximum follow up was 3 years.
Results: 4 patients suffered from unilateral and 6 patients from bilateral CMV retinitis. 14 eyes underwent uneventful ganciclovir implant surgery. The implant was exchanged on patient's desire or if no immune reconstitution occured in 5 cases after an average time of 14 months. One fellowe eye was primary implanted during follow up. Another one blinded 1997 due to retinitis despite implant. Tractive retinal detachment early and late after implantation was observed in 6 eyes. PPV with silicone oil filling was performed in 5 eyes and one eye had argon laser treatment. 3 eyes presented initially with retinal detachment. Surgical approach was PPV with silicone oil filling. Silicone oil induced cataracta complicata and phacoemulsification occured for 4 eyes. This was combined once with ganciclovir implantation and once with implant exchange. 3 of 8 eyes with silicone oil tamponade are now free of oil and CMV recurrence. 5 eyes remained oil filled, 1 eye is blinded.
Summary: Ganciclovir implants provide good local control of CMV retinitis and are exchangeable even several times. Long time follow up shows increasing risk of tractive retinal detachment with increasing survival time. At this stage PPV with prolonged silicone oil tamponade is the only successful therapy with wellknown side effects.
1Krankenhaus Neukölln, Department of Ophthalmology, Rudower Str. 48, 12313 Berlin,
2 Drakestr. 32, 12205 Berlin