Jabs D A
Wilmer Ophthalmological Institute, Baltimore, Maryland 21205, USA.
Infect Agents Dis. 1995 Sep;4(3):131-42.
Cytomegalovirus (CMV) retinitis is the most common intraocular infection in patients with AIDS. Untreated, CMV retinitis is a binding disease. Ganciclovir, a nucleoside analog, and foscarnet, a pyrophosphate analog, are both effective in controlling CMV retinitis. A randomized, controlled, comparative trial of foscarnet and ganciclovir demonstrated that they were equivalent in terms of controlling CMV retinits, but that foscarnet was associated with a longer survival, possibly due to an antiretroviral effect of foscarnet. However, foscarnet was less well tolerated than ganciclovir, primarily due to the nature of its side effects. Because foscarnet and ganciclovir have different side effects, initial treatment of CMV retinitis should be individualized. Newer technological developments, including oral ganciclovir and the ganciclovir intraocular device, may influence the choice of initial treatment, particularly because of their effect on the quality of life when compared to chronic intravenous therapy. The occurrence of relapse and the development of resistance remain long-term concerns, which may alter the use of anti-CMV drugs over time.
巨细胞病毒（CMV）视网膜炎是艾滋病患者中最常见的眼部感染。若不治疗，CMV视网膜炎是一种致盲性疾病。更昔洛韦（一种核苷类似物）和膦甲酸钠（一种焦磷酸盐类似物）在控制CMV视网膜炎方面均有效。一项关于膦甲酸钠和更昔洛韦的随机对照比较试验表明，它们在控制CMV视网膜炎方面效果相当，但膦甲酸钠与更长的生存期相关，这可能归因于膦甲酸钠的抗逆转录病毒作用。然而，膦甲酸钠的耐受性不如更昔洛韦，主要是因其副作用的性质所致。由于膦甲酸钠和更昔洛韦有不同的副作用，CMV视网膜炎的初始治疗应个体化。包括口服更昔洛韦和更昔洛韦眼内装置在内的新技术发展，可能会影响初始治疗的选择，特别是与慢性静脉治疗相比，它们对生活质量有影响。复发的发生和耐药性的发展仍是长期关注的问题，随着时间的推移可能会改变抗CMV药物的使用。
