May 31, 2019 Conference
Purpose: The purpose of this study was to report the incidence of, and to estimate the risk factors associated with, the development of second eye involvement and retinal detachment in a cohort of HIV-infected patients with cytomegalovirus (CMV) retinitis receiving treatment with intravitreal ganciclovir.
Design: Prospective interventional cohort study.
Participants: This study included HIV-infected patients with newly-diagnosed cytomegalovirus retinitis who presented to the ophthalmology clinic at Maharaj Nakorn Hospital in Chiang Mai, Thailand between May 2013 and March 2016.
Methods: Patients with CMV retinitis underwent dilated fundus examinations and received treatment with intravitreal ganciclovir according to a standardized schedule for 12 months. The incidence of second eye involvement of CMV retinitis and new-onset retinal detachment were assessed and baseline risk factors for both outcomes were analyzed using a Cox proportional hazards model, adjusted for the patient’s CD4 count and treatment with highly-active antiretroviral therapy (HAART).
Main Outcome Measures: Two main outcomes were pre-specified: (1) contralateral CMV retinitis in participants with initially unilateral disease (second eye involvement), and (2) new onset of retinal detachment.
Results: A total of 111 eyes with CMV retinitis from 76 HIV-infected patients were included in the cohort study. Of the 49 participants with unilateral CMV retinitis at enrollment, 7 developed second eye involvement over the first 3 months of follow-up (incidence 4.8 per 100 person-months, 95% CI 1.9 to 9.8). None of the person-level or eye-level baseline characteristics were predictive of subsequent second eye involvement at 3 months. Of the 105 eyes without a retinal detachment at the time of initial diagnosis, 6 eyes from 6 people developed a retinal detachment over the first 3 months of follow-up (eye-level incidence: 2.0 per 100 eye-months, 95% CI 0.7 to 4.3; person-level incidence: 2.9 per 100 person-months, 95% CI 1.0 to 6.2). None of the person-level or eye-level baseline covariates had a significant association with subsequent retinal detachment.
Conclusions: The incidence rates of retinal detachment among patients in this cohort study receiving intravitreal ganciclovir injections were similar to rates among other studied populations in the HAART era, suggesting that intravitreal anti-CMV therapy does not substantially increase retinal detachment risk. In addition, the development of contralateral eye involvement of CMV retinitis was still relatively common, highlighting the necessity for more affordable systemic anti-CMV therapy to narrow treatment disparities and effectively treat the global burden of CMV retinitis.