Treatment outcomes of reduced-dose intravitreal ganciclovir for acquired immunodeficiency syndrome patients with cytomegalovirus retinitis

Q4 Medicine

中华眼底病杂志 Pub Date : 2020-04-25 DOI:10.3760/CMA.J.CN511434-20190214-00048

Xuemei Liang, Shan-Shan Chen, G. Yin

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引用次数: 1

Abstract

Objective To evaluate the efficacy and safety of reduced-dose intravitreal ganciclovir for the treatment of acquired immunodeficiency syndrome (AIDS) patients with cytomegalovirus retinitis (CMVR). Methods A prospective observational cohort study observed 15 AIDS patients (28 eyes) who suffered from CMVR onset between January 2016 and December 2018 at Nanning Aier Eye Hospital. Among this 28 eyes, BCVA of 6 eyes (21.4%) were between moving hand to counting finger, 15 eyes (53.6%) were between 0.02 to 0.1 and 7 eyes were better than 0.1 (25.0%). All eyes received intravitreal injection 0.1 ml of ganciclovir at 4 mg/ml (contain ganciclovir 0.4 mg). The induction regimen was twice weekly for 2 weeks and a maintenance period of the same dose weekly. The mean number of injections was 7.1±1.7 times. For hospitalized patients who had no contraindicated received a 14-day twice daily intravenous ganciclovir (IVG) 5.0 mg/kg·d until complete resolution of CMVR. All patients were divided into intravitreal ganciclovir (IVTG) group and IVTG+IVG group according to different treatment plans, which were 5 cases with 8 eyes and 10 cases with 20 eyes, respectively. The follow-up was more than 6 months. BCVA, complete resolution or stable of the lesion and complications were observed. Results Six months later, 20 eyes (71.4%) had a obvious reduced or disappeared of the anterior chamber and vitreous inflammation, and the retinal lesions became stable or complete resolution. 24 eyes showed improvements of BCVA and 4 eyes showed stable. 2 eyes (7.1%) presented with BCVA ≤ counting finger, 7 eyes (25.0%) were 0.02- 0.1 and 19 eyes were ≥ 0.1 (67.9%). Compared with before treatment, the ratio of BCVA that less than or equal to counting finger and between 0.02 to 0.1 decreased(21.4% vs 7.1% and 53.6% vs 25.0%, respectively), but the ratio of BCVA better than 0.1 increased (25.0% vs 67.9%). When IVTG+IVG group was compared with IVTG group, the average time-to-resolution of CMVR were 83.2±25.2 and 85.3±24.4 days respectively. There was no significant difference in resolution times(Z=0.17, P=0.87). The ratio of retinal lesions became stable or complete resolution were 75.0% (15 eyes) and 62.5% (5 eyes), there was no evident difference in time-to-resolution between the two groups (F=0.42, P=0.51). No recurrence was seen during the follow-up period. In cases of unilateral CMVR, there were no patients with a second eye involvement during the follow-up period. No endophthalmitis, vitreous hemorrhage, retinal detachment were found in our study. Conclusion Reduced-dose intravitreal ganciclovir is a safe and effective treatment option for CMVR. Key words: Acquired immunodeficiency syndrome/complications; Cytomegalovirus retinitis/drug therapy; Ganciclovir/therapeutic use; Treatment outcome

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小剂量玻璃体内注射更昔洛韦治疗获得性免疫缺陷综合征伴巨细胞病毒视网膜炎的疗效

目的评价玻璃体内小剂量更昔洛韦治疗获得性免疫缺陷综合征(AIDS)患者巨细胞病毒视网膜炎(CMVR)的疗效和安全性。方法采用前瞻性观察队列研究，对2016年1月至2018年12月在南宁市爱尔眼科医院发生CMVR的艾滋病患者15例(28只眼)进行观察。28只眼中，6只眼(21.4%)的BCVA介于动手到数指之间，15只眼(53.6%)的BCVA介于0.02 ~ 0.1之间，7只眼(25.0%)优于0.1。所有眼玻璃体内注射更昔洛韦4mg /ml 0.1 ml(含更昔洛韦0.4 mg)。诱导方案为每周2次，连续2周，维持期为每周相同剂量。平均注射次数为7.1±1.7次。对于无禁忌症的住院患者，给予更昔洛韦(IVG) 5.0 mg/kg·d，静脉注射14天，每日2次，直至CMVR完全消退。所有患者根据治疗方案不同分为玻璃体内注射更昔洛韦(IVTG)组和IVTG+IVG组，分别为5例8眼和10例20眼。随访6个月以上。观察BCVA、病变完全消退或稳定及并发症。结果6个月后，20只眼(71.4%)前房及玻璃体炎症明显缩小或消失，视网膜病变稳定或完全消退。24眼BCVA改善，4眼稳定。BCVA≤数指2眼(7.1%)，0.02 ~ 0.1 7眼(25.0%)，≥0.1 19眼(67.9%)。与治疗前相比，小于等于数指、0.02 ~ 0.1的BCVA比例下降(分别为21.4%比7.1%和53.6%比25.0%)，优于0.1的BCVA比例上升(25.0%比67.9%)。IVTG+IVG组与IVTG组比较，CMVR的平均解决时间分别为83.2±25.2天和85.3±24.4天。两组的分辨时间差异无统计学意义(Z=0.17, P=0.87)。视网膜病变稳定或完全消退的比例分别为75.0%(15只眼)和62.5%(5只眼)，两组间的痊愈时间差异无统计学意义(F=0.42, P=0.51)。随访期间未见复发。在单侧CMVR病例中，随访期间没有患者出现第二眼受累。本研究未发现眼内炎、玻璃体出血、视网膜脱离。结论玻璃体内小剂量更昔洛韦治疗CMVR是一种安全有效的治疗方法。关键词:获得性免疫缺陷综合征/并发症;巨细胞病毒性视网膜炎/药物治疗;更昔洛韦/治疗用途;治疗结果

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来源期刊

中华眼底病杂志 Medicine-Ophthalmology

CiteScore

0.40

自引率

0.00%

发文量

5383

期刊介绍： Chinese Journal of Ocular Fundus Diseases is the only scientific journal in my country that focuses on reporting fundus diseases. Its purpose is to combine clinical and basic research, and to give equal importance to improvement and popularization. It comprehensively reflects the leading clinical and basic research results of fundus disease disciplines in my country; cultivates professional talents in fundus disease, promotes the development of fundus disease disciplines in my country; and promotes academic exchanges on fundus disease at home and abroad. The coverage includes clinical and basic research results of posterior segment diseases such as retina, uveal tract, vitreous body, visual pathway, and internal eye diseases related to systemic diseases. The readers are medical workers and researchers related to clinical and basic research of fundus diseases. According to the journal retrieval report of the Chinese Institute of Scientific and Technological Information, the comprehensive ranking impact factor and total citation frequency of the Chinese Journal of Ocular Fundus Diseases have been among the best in the disciplines of ophthalmology, otolaryngology, and ophthalmology in my country for many years. The papers published have been included in many important databases at home and abroad, such as Scopus, Peking University Core, and China Science Citation Database (CSCD).