Correspondence

Efficacy of Intravitreal Foscarnet in a Patient with AIDS

N Engl J Med 1994; 330:868-869March 24, 1994

Article

To the Editor:

Cytomegalovirus retinitis is a leading cause of morbidity in patients with AIDS. Although it is optimally treated systemically with either ganciclovir or foscarnet, intraocular therapy is becoming increasingly popular. We report here the response of a patient to intravitreal foscarnet without concomitant systemic therapy.

The patient, a 59-year-old Hispanic man with AIDS, was given a diagnosis of cytomegalovirus retinitis of the left eye in November 1992 (Figure 1AFigure 1Ophthalmoscopic Images of the Left Eye of a Patient with Cytomegalovirus Retinitis and AIDS, before (Panel A) and after (Panel B) Treatment with Intravitreal Foscarnet.). He was treated systemically with ganciclovir as induction therapy and then in maintenance doses.

On June 14, 1993, the patient had a visual acuity of 20/200 in the left eye. An area of active disease surrounding the optic nerve and involving both major temporal arcades threatened his sight1,2. It was decided to begin induction therapy again with systemic ganciclovir immediately, in addition to intravitreal injections with foscarnet. However, the systemic reinduction therapy was not carried out.

Intravitreal therapy was given as described by Diaz-Llopis et al.3.; however, we injected the drug every 48 hours for a total of four doses over a period of eight days as the induction portion of the therapy. Each injection contained 1200 μg of foscarnet in a volume of 0.1 ml. The patient's vision began to improve by the second visit, when it was 20/70. One week later, at the completion of the series, the patient's visual acuity was 20/50, and the retinal picture was improved. After the induction injections, there was no evidence of continuing activity. Only some old retinal hemorrhage on the nasal side of the optic nerve remained (Figure 1B). The patient mentioned at this time that he had never been treated again with his initial systemic medications.

Ideally, patients with cytomegalovirus retinitis should be treated systemically, since cytomegalovirus is a systemic disease. However, there are patients with persistent sight-threatening retinitis despite adequate systemic therapy. We have reported that intravitreal ganciclovir can control the retinitis in these patients4. The anatomical and functional success in this patient suggests that intravitreal therapy with foscarnet should also be considered as a means of controlling cytomegalovirus retinitis.

Ronni M. Lieberman, M.D.
Juan Orellana, M.D.
Mount Sinai School of Medicine, New York, NY 10029

R. Christine Melton, M.D.
Cabrini Medical Center, New York, NY 10003

4 References

1. 1

   Gross JG, Bozzette SA, Mathews WC, et al. Longitudinal study of cytomegalovirus retinitis in acquired immune deficiency syndrome. Ophthalmology 1990;97:681-686
   Web of Science | Medline

2. 2

   Holland GN, Sakamoto MJ, Hardy D, et al. Treatment of cytomegalovirus retinopathy in patients with acquired immunodeficiency syndrome: use of experimental drug 9-[2-hydroxy-1-(hydroxymethyl)ethoxymethyl]guanine. Arch Ophthalmol 1986;104:1794-1800
   Web of Science | Medline

3. 3

   Diaz-Llopis M, Chipont E, Sanchez S, Espana E, Navea A, Menezo JL. Intravitreal foscarnet for cytomegalovirus retinitis in a patient with acquired immunodeficiency syndrome. Am J Ophthalmol 1992;114:742-747
   Web of Science | Medline

4. 4

   Lieberman R, Orellana J. Intraocular ganciclovir in patients with persistent active cytomegalovirus retinitis. In: Program and Abstracts of the Ninth International Conference on AIDS, Berlin, Germany, June 6-11, 1993. London: Wellcome Foundation, 1993:423. abstract.
   

Citing Articles (5)

Citing Articles

1. 1

   Suiyi Tan, Shuwen Liu, Shibo Jiang. (2011) Pathogenesis and treatment of human immunodeficiency virus-associated cytomegalovirus retinitis. Future Virology 6:4, 503-520
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   Shalaby Shalaby, Marc Shalaby. 2003. Polyethylene Glycol-Based Copolyesters. .
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3. 3

   David C Ritterband, Dorothy N. Friedberg. (1998) Virus infections of the eye. Reviews in Medical Virology 8:4, 187-201
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4. 4

   M Dunbar. (1997) The presence of HIV infection in a hospital-based primary care setting. Clinical Eye and Vision Care 9:1, 3-12
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5. 5

   Laurence Gérard, Dominique Salmon-Céron. (1995) Pharmacology and clinical use of foscarnet. International Journal of Antimicrobial Agents 5:4, 209-217
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