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CMV retinitis

• Overview
• Symptoms
• Treatment
• Prevention

Treatment:

The objective of treatment is to prevent progression of the disease, which can lead to blindness. Therapy must be continued indefinitely, or until blindness occurs. Intravenous ganciclovir, foscarnet, and cidofovir have all been shown to improve CMV retinitis.

Once the patient is improving, the oral formulation of the drug, called valgancioclovir, may be taken instead, although CMV is sometimes resistant to these drugs. Also, ganciclovir can deplete white blood cells, and cidofovir and foscarnet can cause kidney damage.

Ganciclovir and foscarnet can also be given as intravitreal implants, which are small capsules of medications surgically inserted into the eye. They deliver a very high dose of medication to the eye.

Oral anti-CMV agents should be taken along with the implants, which must be changed every eight months. These implants have been shown to be beneficial in reducing progression of CMV retinitis.

Fomivirsen, a drug recently approved by the FDA, is injected directly into the eye.

Expectations (prognosis):

Progression of the disease is common, even when therapy continues, because antiviral medications stop the replication of the virus but do not destroy it. CMV is itself immunosuppressive and may worsen the symptoms of other causes of immunosuppression .

Complications:

• retinal detachment
• blindness
• low white blood cell count with use of ganciclovir
• kidney impairment with use of foscarnet

Calling your health care provider:

If symptoms worsen or do not improve with treatment, or if new symptoms develop, call your health care provider.

• Review Date: 2/13/2006
• Reviewed By: Monica Gandhi, M.D., M.P.H., Assistant Professor, Division of Infectious Diseases, UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network.

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