Multiple intravitreal injections of ganciclovir for cytomegalovirus retinitis after stem-cell transplantation

Medical Ophthalmology



Cytomegalovirus (CMV) infection is a major cause of morbidity and mortality in patients after hematopoietic stem cell transplantation (HSCT). Although much effort has been put into dealing with CMV retinitis secondary to acquired immunodeficiency syndrome (AIDS), the few reports which have been published have mainly focused on treatment of CMVR after HSCT.


This clinical interventional retrospective study included 14 patients (eight men; mean age 23.89 ± 12.09; 23 eyes) who suffered from CMV retinitis after stem-cell transplantation, in order to evaluate the efficacy and safety of multiple intravitreal injections of ganciclovir (IVG) for patients with CMV retinitis. All patients received 4 injections of IVG of 1 mg at 1 week intervals, and were followed up weekly for at least 2 months with measurement of best-corrected visual acuity (BCVA) and CMV levels in anterior aqueous humor with real-time polymerase chain reaction. Anterior aqueous humor was obtained before each injection.


The levels of CMV in anterior aqueous humor showed significant decrease from (6.34 ± 15.78) × 105 copies/ml at baseline to (5.22 ± 12.15) × 103 copies/ml at 1 month (P < 0.001, Mann–Whitney U test). CMV couldn’t be detected in 11 eyes (47.8 %) after two injections, and this rose to 18 eyes (78.3 %) at 1 month. The mean logMAR BCVA was 0.659 ± 0.572 at baseline and 0.680 ± 0.527 at 2 months, which suggested no significant improvement (P = 0.736, Mann–Whitney U test) during the procedure. All patients experienced improved vitreous opacity and diminished area of the lesion under funduscopy after 4 injections of IVG. No severe complications developed.


Multiple IVG seemed to be beneficial for patients with CMV retinitis after stem-cell transplantation, in reducing CMV levels in aqueous humor. Further study to optimize the dose of ganciclovir is needed in order to achieve better treatment outcomes.


Ganciclovir Intravitreal injection Cytomegalovirus retinitis Transplant 


  1. 1.
    Teoh SC, Wang PX, Wong EP (2012) The epidemiology and incidence of cytomegalovirus retinitis in the HIV population in Singapore over 6 years. Invest Ophthalmol Vis Sci 53:7546–7552PubMedCrossRefGoogle Scholar
  2. 2.
    Michael WS (2010) Optimal management of cytomegalovirus retinitis in patients with AIDS. Clin Ophthalmol 4:285–299Google Scholar
  3. 3.
    Staras SAS, Dollard SC, Radford KW, Flanders WD, Pass RF, Cannon MJ (2006) Prevalence of cytomegalovirus infection in the United States, 1988–1994. Clin Infect Dis 43:1143–1151PubMedCrossRefGoogle Scholar
  4. 4.
    Broers AE, van Der Holt R, van Esser JW, Gratama JW, Henzen-Logmans S, Kuenen-Boumeester V, Löwenberg B, Cornelissen JJ (2000) Increased transplantrelated morbidity and mortality in CMV-seropositive patients despite highly effective prevention of CMV disease after allogeneic T-celldepleted stem cell transplantation. Blood 95:2240PubMedGoogle Scholar
  5. 5.
    Martin DF, Sierra-Madero J, Walmsley S, Wolitz RA, Macey K, Georgiou P, Robinson CA, Stempien MJ, Valganciclovir Study Group (2002) A controlled trial of valganciclovir as induction therapy for cytomegalovirus retinitis. N Engl J Med 346:1119PubMedCrossRefGoogle Scholar
  6. 6.
    Xhaard A, Robin M, Scieux C, de Latour RP, Deplus S, Mazeron MC, Devergie A, Espérou H, Rocha V, Gluckman E, Ribaud P, Socié G (2007) Increased incidence of cytomegalovirus retinitis after allogeneic hematopoietic stemcell transplantation. Transplantation 83:80–83PubMedCrossRefGoogle Scholar
  7. 7.
    Blank BS, Meenhorst PL, Pauw W, Mulder JW, van Dijk WC, Smits PH, Roeles F, Middeldorp JM, Lange JM (2002) Detection of late pp 67-mRNA by NASBA in peripheral blood for the diagnosis of human cytomegalovirus disease in AIDS patients. J Clin Virol 25:29–38PubMedCrossRefGoogle Scholar
  8. 8.
    Au Eong KG, Beatty S, Charles SJ (1999) Cytomegalovirus retinitis in patients with acquired immune deficiency syndrome. Postgrad Med J 75:585–590PubMedGoogle Scholar
  9. 9.
    Cochereau-Massin I, LeHoang P, Lautier-Frau M, Zazoun L, Marcel P, Robinet M, Matheron S, Katlama C, Gharakhanian S, Rozenbaum W (1991) Efficacy and tolerance of intravitreal ganciclovir in cytomegalovirus retinitis in acquired immune deficiency syndrome. Ophthalmology 98:1348–1353PubMedGoogle Scholar
  10. 10.
    Henry K, Cantrill H, Fletcher C, Chinnock BJ, Balfour HH Jr (1987) Use of intravitreal ganciclovir (dihydroxy propoxymethyl guanine) for cytomegalovirus retinitis in a patient with AIDS. Am J Ophthalmol 103:17–23PubMedGoogle Scholar
  11. 11.
    Young SH, Morlet N, Heery S, Hollows FC, Coroneo MT (1992) High dose intravitreal ganciclovir in the treatment of cytomegalovirus retinitis. Med J Aust 157:370–373PubMedGoogle Scholar
  12. 12.
    Teoh SC, Ou X, Lim TH (2011) Intravitreal ganciclovir maintenance injection for cytomegalovirus retinitis: efficacy of a low-volume, intermediate-dose regimen. Ophthalmology 119:588–595PubMedCrossRefGoogle Scholar
  13. 13.
    Mota A, Breda J, Silva R, Magalhães A, Falcão-Reis F (2011) Cytomegalovirus retinitis in an Immunocompromised Infant: a case report and review of the literature. Case Report Ophthalmol 2:238–242CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Department of Ophthalmology, People’s Hospital, Key Laboratory of Vision Loss and Restoration, Ministry of EducationPeking UniversityBeijingChina

Personalised recommendations