CMV retinitis

Alternative names:

chorioretinitis

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 drugs can sometimes be taken orally instead. Sometimes, however, CMV is 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. Intravitreal implants are small capsules of medications surgically inserted into the eye that 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. Antiviral medications stop the replication of the virus but do not destroy it. CMV is in itself immunosuppressive and may worsen the symptoms of other causes of immunosuppression.

Calling your health care provider:

Call your health care provider if symptoms worsen or do not improve with treatment.

Call your health care provider if new symptoms develop.

Update Date: 04/01/00

Updated By: Luis A. Diaz, Jr. M.D., Johns Hopkins Medical Institute, VeriMed Health Network