Progression rates of cytomegalovirus retinopathy in ganciclovir-treated and untreated patients.

Cytomegalovirus retinopathy lesions in patients with the acquired immunodeficiency syndrome may continue to enlarge despite ganciclovir sodium treatment. In an historical cohort study, we used serial, masked retinal photographs to calculate progression rates for 14 ganciclovir-treated patients known to have disease progression and for 17 untreated patients. The median period of evaluation was 23.5 days for ganciclovir-treated patients and 28 days for untreated patients (P = .89). In both groups, the rate at which borders of preexisting lesions advanced into uninfected retina varied in different directions. Anterior progression rates were usually faster than posterior progression rates. The median progression rate with which disease approached the fovea in ganciclovir-treated patients was 11.5 microns/d (range, 0 to 25.0 microns/d) and the median progression rate for untreated patients was 24.0 microns/d (range, 0 to 164.0 microns/d) (P = .01). These results suggest that ganciclovir provides a therapeutic benefit for patients with progressive disease by slowing the rate with which infection spreads. The size and appearance of lesions may also be related to their response to treatment and to progression rates of untreated disease.