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Ganciclovir Implant Exchange: Timing, Surgical Procedure, and Complications

Ganciclovir Implant Exchange: Timing, Surgical Procedure, and Complications Abstract Background: The ganciclovir implant is effective for the treatment of cytomegalovirus (CMV) retinitis. The device eventually runs out of drug, however, and must be replaced. We report our experience with exchanging ganciclovir implants during the course of a randomized clinical trial. Methods: During our study, patients with newly diagnosed peripheral CMV retinitis were treated with a ganciclovir implant. The implant was scheduled for exchange at 32 weeks. It was exchanged earlier if progression of CMV retinitis occurred. Patient examinations and standard fundus photography were performed at 2-week intervals after the exchange procedure. Results: Twenty-six exchange procedures were performed. Twenty-two eyes in 15 patients received a second implant and 4 eyes in 4 patients later received a third implant. Cytomegalovirus retinitis was rendered or maintained inactive in 22 of 23 cases with more than 1 month of follow-up after the second or third implants. Complications after the second implant procedure included transient vitreous hemorrhage in 5 eyes, postoperative inflammation in 1 eye, and retinal detachment in 1 eye. Median visual acuity returned to 20/25 by 28 days and to 20/20 by 42 days. Complications after the third implant procedure included dense vitreous hemorrhage in 3 of 4 eyes. Median survival time after a second implant procedure was 89 days. Conclusions: The initial ganciclovir implant exchange procedure is well tolerated with continued long-term control of CMV retinitis. Multiple reentries through the same wound may be associated with an increased risk for vitreous hemorrhage. References 1. Smith TJ, Pearson PA, Blandford DL, et al. Intravitreal sustained-release ganciclovir . Arch Ophthalmol . 1992;110:255-258.Crossref 2. Sanborn GE, Anand R, Torti RE, et al. Sustained-release ganciclovir therapy for treatment of cytomegalovirus retinitis: use of an intravitreal device . Arch Ophthalmol . 1992;110:188-195.Crossref 3. Anand R, Nightingale SD, Fish RH, Smith TJ, Ashton P. Control of cytomegalovirus retinitis using sustained release of intraocular ganciclovir . Arch Ophthalmol . 1993;111:223-237.Crossref 4. Martin DF, Parks DJ, Mellow SD, et al. Treatment of cytomegalovirus retinitis with an intraocular sustained-release ganciclovir implant: a randomized controlled clinical trial . Arch Ophthalmol . 1994;112:1531-1539.Crossref 5. Drew WL, Ives D, Lalezari JP, et al. Oral ganciclovir as maintenance treatment for cytomegalovirus retinitis in patients with AIDS . N Engl J Med . 1995;333:615-620.Crossref 6. Hoover DR, Peng Y, Saah A, et al. Occurence of cytomegalovirus retinitis after human immunodeficiency virus immunosuppression . Arch Ophthalmol . 1996;114:821-827.Crossref 7. Lalezari J, Friedberg D, Bisset J, Giordano M, Hardy D, Robinson C. A comparison of the safety and efficacy of 3 g, 4.5 g, and 6 g doses of oral ganciclovir versus IV ganciclovir for maintenance treatment of CMV retinitis. Presented at the 11th International Conference on AIDS; July 7,1996: Vancouver, British Columbia. 8. Ferris FL III, Kassoff A, Bresnick GH, Bailey I. New visual acuity charts for clinical research . Am J Ophthalmol . 1982;94:91-96. 9. Freeman WR, Friedberg DN, Berry C, et al. Risk factors for development of rhegmatogenous retinal detachment in patients with cytomegalovirus retinitis . Am J Ophthalmol . 1993;116:713-720. 10. Kuppermann BD, Quiceno JI, Flores-Aguilar M, et al. Intravitreal ganciclovir concentration after intravenous administration in AIDS patients with cytomegalovirus retinitis: implications for therapy . J Infect Dis . 1993;168:1506-1509.Crossref 11. Arevalo JF, Gonzalez C, Capparelli EV, et al. Intravitreous and plasma concentrations of ganciclovir and foscarnet after intravenous therapy in patients with AIDS and cytomegalovirus retinitis . J Infect Dis . 1995;172:951-956.Crossref 12. Palestine A, Stevens G, Lane HC, et al. Treatment of cytomegalovirus retinitis with dihydroxy propoxymethyl guanine . Am J Ophthalmol . 1986;101:95-101. 13. Collaborative DHPG Treatment Study Group. Treatment of serious cytomegalovirus infections with 9-(1,3-dihydroxy-2-propoxymethyl) guanine in patients with AIDS and other immunodeficiencies . New Engl J Med . 1986;314:801-805.Crossref 14. Holland GN, Sidikaro Y, Kreiger AE, et al. Treatment of cytomegalovirus retinopathy with ganciclovir . Ophthalmology . 1987;94:815-822.Crossref 15. Jabs DA, Newman C, DeBustros S, Polk BF. Treatment of cytomegalovirus retinitis with ganciclovir . Ophthalmology . 1987;94:824-830.Crossref 16. Buhles WC Jr, Mastre BJ, Tinker AJ, et al. Ganciclovir treatment of life-or sight-threatening cytomegalovirus infection: experience in 314 immunocompromised patients . Rev Infect Dis . 1988;10( (suppl 3) ):495-506.Crossref 17. Musch DC, Martin DF, Gordon JF, et al. Treatment of cytomegalovirus retinitis with a sustained-release ganciclovir implant: a multicenter, randomized, controlled trial . N Engl J Med . 1997;337:83-90.Crossref 18. Morley MG, Duker JS, Ashton P, Robinson MR. Replacing ganciclovir implants . Ophthalmology . 1995;102:388-392.Crossref 19. Deeks SG, Smith M, Holodniy M, Kahn JD. HIV-I protease inhibitors: a review for clinicians . JAMA . 1997;277:145-153.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1997 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.1997.01100160559005
Publisher site
See Article on Publisher Site

Abstract

Abstract Background: The ganciclovir implant is effective for the treatment of cytomegalovirus (CMV) retinitis. The device eventually runs out of drug, however, and must be replaced. We report our experience with exchanging ganciclovir implants during the course of a randomized clinical trial. Methods: During our study, patients with newly diagnosed peripheral CMV retinitis were treated with a ganciclovir implant. The implant was scheduled for exchange at 32 weeks. It was exchanged earlier if progression of CMV retinitis occurred. Patient examinations and standard fundus photography were performed at 2-week intervals after the exchange procedure. Results: Twenty-six exchange procedures were performed. Twenty-two eyes in 15 patients received a second implant and 4 eyes in 4 patients later received a third implant. Cytomegalovirus retinitis was rendered or maintained inactive in 22 of 23 cases with more than 1 month of follow-up after the second or third implants. Complications after the second implant procedure included transient vitreous hemorrhage in 5 eyes, postoperative inflammation in 1 eye, and retinal detachment in 1 eye. Median visual acuity returned to 20/25 by 28 days and to 20/20 by 42 days. Complications after the third implant procedure included dense vitreous hemorrhage in 3 of 4 eyes. Median survival time after a second implant procedure was 89 days. Conclusions: The initial ganciclovir implant exchange procedure is well tolerated with continued long-term control of CMV retinitis. Multiple reentries through the same wound may be associated with an increased risk for vitreous hemorrhage. References 1. Smith TJ, Pearson PA, Blandford DL, et al. Intravitreal sustained-release ganciclovir . Arch Ophthalmol . 1992;110:255-258.Crossref 2. Sanborn GE, Anand R, Torti RE, et al. Sustained-release ganciclovir therapy for treatment of cytomegalovirus retinitis: use of an intravitreal device . Arch Ophthalmol . 1992;110:188-195.Crossref 3. Anand R, Nightingale SD, Fish RH, Smith TJ, Ashton P. Control of cytomegalovirus retinitis using sustained release of intraocular ganciclovir . Arch Ophthalmol . 1993;111:223-237.Crossref 4. Martin DF, Parks DJ, Mellow SD, et al. Treatment of cytomegalovirus retinitis with an intraocular sustained-release ganciclovir implant: a randomized controlled clinical trial . Arch Ophthalmol . 1994;112:1531-1539.Crossref 5. Drew WL, Ives D, Lalezari JP, et al. Oral ganciclovir as maintenance treatment for cytomegalovirus retinitis in patients with AIDS . N Engl J Med . 1995;333:615-620.Crossref 6. Hoover DR, Peng Y, Saah A, et al. Occurence of cytomegalovirus retinitis after human immunodeficiency virus immunosuppression . Arch Ophthalmol . 1996;114:821-827.Crossref 7. Lalezari J, Friedberg D, Bisset J, Giordano M, Hardy D, Robinson C. A comparison of the safety and efficacy of 3 g, 4.5 g, and 6 g doses of oral ganciclovir versus IV ganciclovir for maintenance treatment of CMV retinitis. Presented at the 11th International Conference on AIDS; July 7,1996: Vancouver, British Columbia. 8. Ferris FL III, Kassoff A, Bresnick GH, Bailey I. New visual acuity charts for clinical research . Am J Ophthalmol . 1982;94:91-96. 9. Freeman WR, Friedberg DN, Berry C, et al. Risk factors for development of rhegmatogenous retinal detachment in patients with cytomegalovirus retinitis . Am J Ophthalmol . 1993;116:713-720. 10. Kuppermann BD, Quiceno JI, Flores-Aguilar M, et al. Intravitreal ganciclovir concentration after intravenous administration in AIDS patients with cytomegalovirus retinitis: implications for therapy . J Infect Dis . 1993;168:1506-1509.Crossref 11. Arevalo JF, Gonzalez C, Capparelli EV, et al. Intravitreous and plasma concentrations of ganciclovir and foscarnet after intravenous therapy in patients with AIDS and cytomegalovirus retinitis . J Infect Dis . 1995;172:951-956.Crossref 12. Palestine A, Stevens G, Lane HC, et al. Treatment of cytomegalovirus retinitis with dihydroxy propoxymethyl guanine . Am J Ophthalmol . 1986;101:95-101. 13. Collaborative DHPG Treatment Study Group. Treatment of serious cytomegalovirus infections with 9-(1,3-dihydroxy-2-propoxymethyl) guanine in patients with AIDS and other immunodeficiencies . New Engl J Med . 1986;314:801-805.Crossref 14. Holland GN, Sidikaro Y, Kreiger AE, et al. Treatment of cytomegalovirus retinopathy with ganciclovir . Ophthalmology . 1987;94:815-822.Crossref 15. Jabs DA, Newman C, DeBustros S, Polk BF. Treatment of cytomegalovirus retinitis with ganciclovir . Ophthalmology . 1987;94:824-830.Crossref 16. Buhles WC Jr, Mastre BJ, Tinker AJ, et al. Ganciclovir treatment of life-or sight-threatening cytomegalovirus infection: experience in 314 immunocompromised patients . Rev Infect Dis . 1988;10( (suppl 3) ):495-506.Crossref 17. Musch DC, Martin DF, Gordon JF, et al. Treatment of cytomegalovirus retinitis with a sustained-release ganciclovir implant: a multicenter, randomized, controlled trial . N Engl J Med . 1997;337:83-90.Crossref 18. Morley MG, Duker JS, Ashton P, Robinson MR. Replacing ganciclovir implants . Ophthalmology . 1995;102:388-392.Crossref 19. Deeks SG, Smith M, Holodniy M, Kahn JD. HIV-I protease inhibitors: a review for clinicians . JAMA . 1997;277:145-153.Crossref

Journal

Archives of OphthalmologyAmerican Medical Association

Published: Nov 1, 1997

References