Intravitreal ganciclovir yields better vision in eyes with progressive outer retinal necrosis

An early response to intravitreal ganciclovir injection was associated with significantly improved vision in eyes with progressive outer retinal necrosis, a study found.

“By far the most encouraging result from these data appears to be improved visual outcomes associated with early response to intravitreal ganciclovir injections,” the study authors said.

The retrospective, interventional case series included 67 eyes of 39 patients who were HIV positive. Twelve patients died during the study. Eighteen patients were lost to follow-up, but six later returned.

Eyes with active retinitis and potential for light perception or better vision underwent repeated intravitreal injections of ganciclovir. Injections were given twice weekly for 2 weeks and then tapered to once weekly.

When there were no signs of active disease, treatment was tapered to every 2 weeks and continued until highly active antiretroviral therapy-mediated immune reconstitution was confirmed, according to the study.

Mean baseline visual acuity was 6/120; 12 eyes had lost light perception.

Intravitreal ganciclovir injections were administered in 50 eyes that were deemed salvageable. These eyes received a median total of 12 injections.

Study results showed that eyes responding 21 days or less after treatment had the greatest visual improvement (P = .046). These eyes achieved a median final visual acuity of 6/36. Eyes responding after 21 days after treatment had a median final visual acuity of counting fingers.

Retinal detachment was identified in 34 eyes; data showed a statistically significant correlation between retinal detachment and poor visual outcome (P < .001).

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Source:

Arch Ophthalmol. 2012;130(6):700-706.