Pharmacologic management of cytomegalovirus retinitis: review of current and future therapeutic modalities.

BACKGROUND

A number of new medications and modes of drug delivery have been introduced for the management of cytomegalovirus (CMV) retinitis in AIDS patients. New modes of treatment have attempted to prolong intervals between dosing and reduce drug-related toxicity in an effort to improve quality of life.

METHODS

The ophthalmic, infectious disease, and pharmacologic literature were reviewed and evaluated for trends and new approaches to the management of CMV retinitis.

RESULTS

Ganciclovir and foscarnet have been the mainstays in management of CMV retinitis. Intravenous administration of these drugs is costly, time-consuming, and complicated by numerous toxicities. Changes in the delivery of anti-viral drugs have involved intravitreal injections and implant devices. Other new methods involve liposomal systems to increase drug contact time, use of longer-acting drugs with less-frequent dosing requirements, and methods to improve quality of life by avoiding intravenous drug delivery.

CONCLUSIONS

A number of strategies have evolved to manage cytomegalovirus retinitis. Patients are living longer with AIDS. With increased survival comes increased risk of CMV retinitis and the need for more-effective treatments to preserve retinal integrity. The optometrist must become aware of the potential of these drugs to control retinitis, protect functional vision, and maintain quality of life.