Cantrill H L, Henry K, Melroe N H, Knobloch W H, Ramsay R C, Balfour H H
Department of Ophthalmology, University of Minnesota School of Medicine, Minneapolis.
Ophthalmology. 1989 Mar;96(3):367-74. doi: 10.1016/s0161-6420(89)32900-9.
Long-term management of cytomegalovirus (CMV) retinitis by intravitreal injection of ganciclovir was evaluated in ten patients with acquired immune deficiency syndrome (AIDS). Patients were unable to tolerate systemic ganciclovir because of severe neutropenia (8 cases), catheter-induced sepsis (1 case), or the need to continue therapy for human immunodeficiency virus (HIV) with zidovudine (ZDV) (1 case). All patients had a favorable response to initial treatment. Cytomegalovirus retinitis progressed in four fellow eyes in which treatment was deferred. Vision improved or remained stable in all but one eye. Patients were followed for a mean of 4 months and received an average of 16.6 intravitreal injections in each eye. Relapse occurred late in the course while on maintenance treatment in five eyes (33%). There was no evidence of toxicity from repeated intravitreal injections. Treatment was very well tolerated. The only severe complication in a total of 249 injections was a single case of Staphylococcus epidermidis endophthalmitis which responded to intravitreal antibiotic treatment. Intravitreal ganciclovir is an effective alternative to systemic ganciclovir in those patients with severe neutropenia and in those patients who desire to remain on systemic ZDV.
通过玻璃体内注射更昔洛韦对10例获得性免疫缺陷综合征（AIDS）患者巨细胞病毒（CMV）视网膜炎进行长期管理进行了评估。由于严重中性粒细胞减少（8例）、导管相关性败血症（1例）或需要继续使用齐多夫定（ZDV）治疗人类免疫缺陷病毒（HIV）（1例），患者无法耐受全身使用更昔洛韦。所有患者对初始治疗均有良好反应。4例未进行治疗的对侧眼发生了巨细胞病毒视网膜炎进展。除一只眼外，所有眼的视力均有改善或保持稳定。患者平均随访4个月，每只眼平均接受16.6次玻璃体内注射。5只眼（33%）在维持治疗期间病程后期出现复发。没有证据表明反复玻璃体内注射存在毒性。治疗耐受性良好。在总共249次注射中，唯一的严重并发症是1例表皮葡萄球菌眼内炎，经玻璃体内抗生素治疗后有反应。对于严重中性粒细胞减少的患者以及希望继续使用全身ZDV的患者，玻璃体内注射更昔洛韦是全身使用更昔洛韦的有效替代方法。
