高剂量（2000微克）玻璃体内注射更昔洛韦治疗巨细胞病毒性视网膜炎

High-dose (2000-microgram) intravitreous ganciclovir in the treatment of cytomegalovirus retinitis.

作者信息

Young S, Morlet N, Besen G, Wiley C A, Jones P, Gold J, Li Y, Freeman W R, Coroneo M T

机构信息

Department of Ophthalmology, University of New South Wales, Sydney, Australia.

出版信息

Ophthalmology. 1998 Aug;105(8):1404-10. doi: 10.1016/s0161-6420(98)98020-4.

DOI:10.1016/s0161-6420(98)98020-4

PMID:9709750

Abstract

OBJECTIVE

The authors prospectively studied visual outcome, relapse, complications, and survival of patients with acquired immune deficiency syndrome (AIDS)-related cytomegalovirus (CMV) treated with high-dose intravitreous ganciclovir (2 mg/0.1 ml) injections. The outcomes were compared with those of patients treated with standard doses of intravenous ganciclovir in the same institution. The histopathologic and electrophysiologic effects of high-dose intravitreous ganciclovir injections in rabbits also were studied.

DESIGN

A nonrandomized case series.

PARTICIPANTS

A total of 42 patients (74 eyes) were treated with intravitreous injections and 18 patients (27 eyes) were treated with intravenous ganciclovir. Five eyes of three New Zealand white rabbits were injected with ganciclovir, and the sixth eye was a control specimen.

INTERVENTION

Patients treated with intravitreous injections received twice-weekly doses of 2 mg/0.1 ml ganciclovir for 3 weeks, then weekly injections. Patients treated with intravenous ganciclovir received standard doses. Patients were monitored with regular examinations. Rabbit eyes were given intravitreous injections of 1 mg/0.1 ml of ganciclovir weekly for 4 weeks.

MAIN OUTCOME MEASURES

Assessments of vision, retinal inflammation, and survival were made. Electroretinograms were performed on the rabbit eyes, and they were processed for light and electron microscopy.

RESULTS

In the intravitreous group, visual acuity (VA) was stable in 64 of 74 eyes, 5 improved, and 5 deteriorated. Sixty-three (85%) of 74 eyes had final VA of 20/20 to 20/40. Relapse occurred in five eyes (7%; median time, 42 weeks). There were three cases of endophthalmitis. Median survival after diagnosis of CMV retinitis was 36 weeks. In the intravenous group, VA was stable in 18 eyes, 0 improved, and 9 deteriorated. Sixteen (59%) of 27 eyes had final VA of 20/20 to 20/40. Relapse occurred in 15 eyes (56%) at a median time of 21 weeks. Median survival was 21 weeks. The rabbit studies showed no evidence of toxicity.

CONCLUSION

High-dose intravitreous ganciclovir effectively suppressed CMV retinitis, preserved vision, and prevented relapse without deterioration in survival.

摘要

目的

作者前瞻性研究了接受高剂量玻璃体内注射更昔洛韦（2mg/0.1ml）治疗的获得性免疫缺陷综合征（AIDS）相关巨细胞病毒（CMV）患者的视力转归、复发情况、并发症及生存率。将这些结果与在同一机构接受标准剂量静脉注射更昔洛韦治疗的患者进行比较。还研究了高剂量玻璃体内注射更昔洛韦对兔的组织病理学和电生理影响。

设计

非随机病例系列。

参与者

共42例患者（74只眼）接受玻璃体内注射治疗，18例患者（27只眼）接受静脉注射更昔洛韦治疗。给3只新西兰白兔的5只眼注射更昔洛韦，第6只眼作为对照标本。

干预

接受玻璃体内注射治疗的患者每周两次接受2mg/0.1ml更昔洛韦注射，共3周，然后每周注射一次。接受静脉注射更昔洛韦治疗的患者接受标准剂量治疗。定期对患者进行检查。给兔眼每周玻璃体内注射1mg/0.1ml更昔洛韦，共4周。

主要观察指标

评估视力、视网膜炎症和生存率。对兔眼进行视网膜电图检查，并进行光镜和电镜处理。

结果

在玻璃体内注射组，74只眼中6�只眼视力稳定，5只眼视力改善，5只眼视力恶化。74只眼中63只眼（85%）最终视力为20/20至20/40。5只眼（7%）复发（中位时间为42周）。发生3例眼内炎。诊断为CMV视网膜炎后的中位生存期为36周。在静脉注射组，18只眼视力稳定，0只眼视力改善，9只眼视力恶化。27只眼中16只眼（59%）最终视力为20/20至20/40。15只眼（56%）复发，中位时间为21周。中位生存期为21周。兔的研究未显示毒性迹象。