Qian Zhuyun, Li Haili, Tao Yong, Li Wensheng
Shanghai Aier Eye Hospital, Shanghai, China, No. 1286, Hongqiao Road, Changning District, Shanghai, 200050, China.
Department of Ophthalmology, the First Hospital of Peking University, Beijing, China.
BMC Ophthalmol. 2018 Dec 10;18(1):314. doi: 10.1186/s12886-018-0983-z.
The purpose of this study is to examine the clinical outcomes achieved by using initial high-dose intravitreal ganciclovir injections to treat cytomegalovirus retinitis in patients without human immunodeficiency virus (HIV) infection.
Twenty-four eyes (24 patients) with cytomegalovirus retinitis received multiple intravitreal injections of ganciclovir in weekly intervals. A higher dose (6 mg) of ganciclovir was applied at the first intravitreal injection, and a lower dose was used for maintenance. Anterior aqueous humour was obtained before each injection. The best-corrected visual acuity and cytomegalovirus loads in the anterior aqueous humour were measured.
The mean cytomegalovirus DNA load in aqueous humour decreased significantly from (2.59 ± 2.28) × 10 copies/mL at baseline to (1 ± 1.76) × 10 copies/mL one month later. The aqueous cytomegalovirus DNA load was negative in 17 eyes (70.8%) one month later. No obvious improvement of best-corrected visual acuity was found during the treatment. A positive correlation was proven between initial cytomegalovirus DNA titers in aqueous humour and the total number of intravitreal injections of ganciclovir, as well as between the baseline and final best-corrected visual acuities. No severe complications developed.
An initial high dose of ganciclovir (6 mg) and continuous intravitreal injections of ganciclovir could significantly decrease the cytomegalovirus load in HIV-negative patients with cytomegalovirus retinitis.
http://clinicaltrials.gov, NCT03598452, retrospectively registered on 24 July 2018.
本研究的目的是探讨在无人类免疫缺陷病毒（HIV）感染的患者中，使用初始高剂量玻璃体内注射更昔洛韦治疗巨细胞病毒性视网膜炎所取得的临床疗效。
24例（24只眼）巨细胞病毒性视网膜炎患者接受每周一次的多次玻璃体内注射更昔洛韦。首次玻璃体内注射时应用较高剂量（6mg）的更昔洛韦，维持注射时使用较低剂量。每次注射前采集眼前房水。测量最佳矫正视力和眼前房水中的巨细胞病毒载量。
前房水中平均巨细胞病毒DNA载量从基线时的（2.59±2.28）×10拷贝/mL显著降至1个月后的（1±1.76）×10拷贝/mL。1个月后，17只眼（70.8%）的房水巨细胞病毒DNA载量为阴性。治疗期间未发现最佳矫正视力有明显改善。房水中初始巨细胞病毒DNA滴度与玻璃体内注射更昔洛韦的总次数之间，以及基线和最终最佳矫正视力之间均存在正相关。未发生严重并发症。
初始高剂量（6mg）更昔洛韦及持续玻璃体内注射更昔洛韦可显著降低HIV阴性的巨细胞病毒性视网膜炎患者的巨细胞病毒载量。
