Kuppermann B D
Department of Ophthalmology, University of California, Irvine 92697, U.S.A.
J Acquir Immune Defic Syndr Hum Retrovirol. 1997;14 Suppl 1:S13-21. doi: 10.1097/00042560-199700001-00004.
Untreated cytomegalovirus (CMV) retinitis is progressive and generally leads to blindness within 6 months. Intravenous (i.v.) therapies such as foscarnet and ganciclovir, which were the first agents approved for the treatment of CMV retinitis, are effective in suppressing CMV replication, but they delay rather than prevent reactivation of CMV infection resulting in relapse of the disease. Furthermore, studies have shown that the time between subsequent reactivations becomes shorter, with each relapse producing more serious disease that may be more difficult to manage. This clinical failure may be caused in part by drug resistance; approximately 10% of all patients receiving systemic treatment with these agents may harbor drug-resistant viral strains. With three systemic therapies (ganciclovir, foscarnet, and cidofovir) now available for the treatment of CMV retinitis, several options exist for patients who have failed therapy with one of these drugs: reinduction with the same i.v. agent, switching therapies, or combining therapies. Resistant or relapsing CMV retinitis may also be treated by local therapies such as intraocular injections of ganciclovir and foscarnet or with a sustained-release ganciclovir implant. However, local therapy is ineffective in controlling extraocular or fellow eye CMV disease. It is likely that the integration of both local and systemic therapies will be required to halt the relentless progression of this debilitating disease, particularly when clinical resistance is encountered.
未经治疗的巨细胞病毒（CMV）视网膜炎呈进行性发展，通常在6个月内导致失明。静脉注射疗法，如膦甲酸钠和更昔洛韦，是最早被批准用于治疗CMV视网膜炎的药物，它们能有效抑制CMV复制，但只能延缓而非预防CMV感染的重新激活，从而导致疾病复发。此外，研究表明，后续重新激活之间的时间间隔会变短，每次复发都会产生更严重的疾病，可能更难治疗。这种临床治疗失败可能部分是由耐药性引起的；接受这些药物全身治疗的所有患者中，约10%可能携带耐药病毒株。目前有三种全身治疗方法（更昔洛韦、膦甲酸钠和西多福韦）可用于治疗CMV视网膜炎，对于使用其中一种药物治疗失败的患者有几种选择：用同一种静脉注射药物重新诱导、更换治疗方法或联合治疗。耐药或复发性CMV视网膜炎也可通过局部治疗，如眼内注射更昔洛韦和膦甲酸钠或使用更昔洛韦缓释植入物来治疗。然而，局部治疗在控制眼外或对侧眼CMV疾病方面无效。可能需要将局部和全身治疗结合起来，才能阻止这种使人衰弱的疾病的持续进展，特别是在遇到临床耐药性时。
