[Cytomegalovirus (CMV) retinitis in AIDS. Gancilovir implantation in comparison with systemic therapy].

INTRODUCTION: Untreated CMV retinitis with AIDS leads to blindness; therefore, a life-long virostatic treatment is required. It can either be administered systemically or locally, as there are different advantages and disadvantages. When treating patients we aim at therapy that preserves vision without diminishing quality of life. It should induce as few drug-induced side effects as possible and not shorten the patient's life expectation.

METHODS AND RESULTS: A total of 111 patients (150 eyes) with systemic maintenance treatment were compared retrospectively with 33 patients (62 eyes) that received a ganciclovir implant only as maintainance therapy and no additional systemic treatment. Patients with an implant showed a prolonged interval of nonprogression of retinitis than patients receiving systemic treatment. Patients with unilateral retinitis are at higher risk of developing bilateral disease in the implant group than in the systemically treated group. Manifestation of extraocular disease was equal in both groups. Local treatment with the implant does not shorten patient survival time.

CONCLUSION: Local treatment with the ganciclovir implant means quality of life for patients and also safe protection of the affected eye. Extraocular disease and survival time are not influenced adversely by local treatment. However, primarily unilateral involved patients show higher risk for bilateral disease in the implant group than in the systemically treated group.