Ganciclovir ocular implant: new preparation. May benefit severely affected AIDS patients

A clinical trial involving 188 HIV-infected patients with cytomegalovirus retinitis compared treatment with the ocular ganciclovir implant and intravenous ganciclovir. Local treatment delayed progression of lesions on the fundus oculi, but the clinical impact on sight was not studied. Local ocular treatment alone failed to delay the onset of retinitis in the other eye and, unlike intravenous treatment, did not protect patients against systemic cytomegalovirus infection. The implants must be inserted surgically and renewed periodically. Local adverse effects are relatively frequent, and include a transient reduction in visual acuity lasting about 15 days, vitreal haemorrhage, retinal detachment and endophthalmia. These implants do not always avoid the need for systemic treatment with its inherent adverse effects (mainly haematological and infectious). In our opinion this local treatment should be reserved for patients with initially severe or rapidly progressive forms, or lesions likely to damage their sight rapidly.