Being Alive; March 1994
Mark Katz, MD and reported by Jim Stoecker

Some researchers are concerned that not enough drug reaches the eye where it is needed if the drug is taken intravenously. A recent study, published in the Journal of Infectious Diseases (December 1993) found low, possibly sub-therapeutic levels of medicine in the eyes of 22 patients who had received IV ganciclovir. These researchers believe further studies are needed in administering ganciclovir intravitreally.

Intravitreal ganciclovir means that, instead of the drug being injected into a vein, the drug is injected directly into the vitreous humor of the eye. This is currently only an experimental procedure, although we have had some reports of success in keeping CMV in remission using this method.

Intravitreal ganciclovir offers the attraction of getting the drug right to where we want it. The drug is not introduced systemically, where it might disturb the white blood count.

On the other hand, other recent studies have shown that people with early CMV retinitis, when given ganciclovir systemically, delay the onset of serious CMV retinitis. If you get CMV in one eye, you are likely to get it in the other eye or in the gut. Intravenous ganciclovir may forestall the spreading of the CMV.

So the debate continues on how best to introduce ganciclovir when treating CMV retinitis. You should be aware of the developing treatment options.

While on the subject of ganciclovir, we should mention that an oral form of ganciclovir is being tested. The problem is that ganciclovir is not easily absorbed by the body. Only a small proportion of the one to six gram oral dosage is actually made use of. Nonetheless, we do have reports of prolonged remission of CMV retinitis in patients using oral ganciclovir as maintenance therapy. Whether it will prove useful as CMV prophylaxis remains to be seen.

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