Rahhal F M, Arevalo J F, Munguia D, Taskintuna I, Chavez de la Paz E, Azen S P, Freeman W R
Department of Ophthalmology, University of California, San Diego School of Medicine, USA.
Ophthalmology. 1996 Jul;103(7):1078-83. doi: 10.1016/s0161-6420(96)30564-2.
To evaluate the efficacy and safety of multiple intravitreal cidofovir (HPMPC) injections given every 5 to 6 weeks for the maintenance treatment of cytomegalovirus (CMV) retinitis.
A prospective consecutive case series of 53 eyes in 35 patients with acquired immune deficiency syndrome and CMV retinitis was treated with maintenance intravitreal injections of cidofovir (20 micrograms) at one referral center between April 1994 and September 1995. Twenty-four eyes received intravitreal cidofovir as their initial treatment for CMV retinitis (group A), and 29 eyes previously had received systemic therapy (group B). None of the patients in either group received systemic anti-CMV therapy at any time during the study period. Progression of retinitis was the primary end point.
All eyes with active retinitis healed in response to treatment. None of the 24 eyes in group A demonstrated any progression during the study period. Four (14%) of the 29 eyes in group B had one episode each of retinitis progression (mean follow-up, 15 weeks; range, 0-58 weeks). In 1 (1.9%) of the 53 eyes, a retinal detachment developed. A mild iritis was observed after 14% of injections, which were prophylaxed with oral probenecid. Irreversible visually significant hypotony developed in two eyes (3.8%).
Treatment and subsequent maintenance therapy of CMV retinitis with 20 micrograms intravitreally injected cidofovir, given at 5- to 6-week intervals, is highly effective, with only rare episodes of re-activation and progression.
评估每5至6周进行多次玻璃体内注射西多福韦（HPMPC）对巨细胞病毒（CMV）视网膜炎维持治疗的疗效和安全性。
1994年4月至1995年9月期间，在一个转诊中心对35例获得性免疫缺陷综合征合并CMV视网膜炎患者的53只眼进行了前瞻性连续病例系列研究，采用玻璃体内注射西多福韦（20微克）进行维持治疗。24只眼接受玻璃体内注射西多福韦作为CMV视网膜炎的初始治疗（A组），29只眼此前接受过全身治疗（B组）。两组患者在研究期间均未接受任何全身抗CMV治疗。视网膜炎进展是主要终点。
所有活动性视网膜炎的眼均对治疗有反应而愈合。A组的24只眼中，在研究期间均未出现任何进展。B组的29只眼中有4只（14%）各有一次视网膜炎进展（平均随访15周；范围0 - 58周）。53只眼中有1只（1.9%）发生了视网膜脱离。14%的注射后观察到轻度虹膜炎，通过口服丙磺舒预防。两只眼（3.8%）出现了不可逆的、有临床意义的低眼压。
每5至6周间隔玻璃体内注射20微克西多福韦对CMV视网膜炎进行治疗及后续维持治疗非常有效，只有罕见的复发和进展情况。
