valganciclovir and Blindness

To determine treatment outcome and risk factors for visual loss in Cytomegalovirus (CMV) endotheliitis.. Retrospective case-note review of all CMV positive endotheliitis patients seen at the Singapore National Eye Center, for demographics, visual acuity (VA), extent of corneal edema, anterior chamber (AC) activity, ocular history, glaucomatous optic neuropathy (GON), and ganciclovir therapy. Outcome measures were VA, corneal edema, and AC activity.. Median age at diagnosis of the 19 patients (21 eyes) was 57 years. Median duration of follow up was 37 months. Sixteen eyes received systemic ganciclovir, and four eyes received ganciclovir gel. The AC inflammation resolved in 19 eyes. The corneal edema resolved in eight eyes, but persisted in 12 eyes. One patient resolved spontaneously. Pre-treatment corneal edema exceeding 75%, older age, GON, and previous corneal graft were risk factors for persistent corneal edema post treatment (P = < 0.001, 0.001, 0.02 and 0.02 respectively, Fisher's exact test), and VA worse than 6/60.. Anterior chamber inflammation resolves with ganciclovir therapy, but severe pre-treatment corneal edema, older age, previous corneal graft, and GON are associated with a poor visual outcome.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Antibodies, Viral; Antiviral Agents; Aqueous Humor; Blindness; Cytomegalovirus; Cytomegalovirus Infections; DNA, Viral; Endothelium, Corneal; Eye Infections, Viral; Female; Follow-Up Studies; Ganciclovir; HIV Antibodies; Humans; Infusions, Intravenous; Keratitis; Male; Middle Aged; Polymerase Chain Reaction; Retrospective Studies; Risk Factors; Treatment Outcome; Valganciclovir; Visual Acuity

Topics: Acquired Immunodeficiency Syndrome; Africa South of the Sahara; AIDS-Related Opportunistic Infections; Anti-Retroviral Agents; Antiviral Agents; Asia, Southeastern; Blindness; CD4 Lymphocyte Count; Cytomegalovirus Retinitis; Developing Countries; Disease Outbreaks; Drug Costs; Ganciclovir; Health Services Accessibility; Humans; Mass Screening; Ophthalmoscopy; Program Development; Treatment Outcome; Valganciclovir

Topics: Aged; AIDS-Related Opportunistic Infections; Antiviral Agents; Blindness; Fatal Outcome; Ganciclovir; Herpes Zoster Ophthalmicus; Humans; Male; Retinal Necrosis Syndrome, Acute; Valganciclovir; Viral Load; Visual Acuity