Cytomegalovirus Can Be Managed With Combined Oral, Intravitreal Treatments

In HIV-negative patients with systemic lymphoma, the oral antiviral drug valganciclovir, in combination with intravitreal foscarnet injections, can successfully treat cytomegalovirus (CMV) retinitis, according to a study published in Eye. This treatment presents an outpatient alternative to the conventional intravenous antiviral treatment.

“The disadvantages of the intravenous antiviral delivery include the necessity for hospitalization in a context of a prolonged treatment,” researchers explain. Special attention has to be taken when visual disturbances present in patients with lymphoma, since the eye can be a site for metastasis, the study says.

For this retrospective case series, the researchers collected information on systemic lymphoma and CMV retinitis patients treated with oral and intravitreal antiviral agents from the Moorfields Eye Hospital database between December 2014 and December 2018. Patient demographics, ophthalmic parameters, treatment patterns, and management for lymphoma/CMV were collected.  

A total of 11 eyes with CMV of 7 patients (median age, 59 [53-76 years]; 57.1% women) were included in this series. Ocular involvement was bilateral in 4 cases. All patients had been undergoing cancer treatments for between 2 and 15 months and were followed for at least 6 months. At baseline ophthalmic evaluation, 5 of the patients were in remission, 1 patient was being treated with chemotherapy, and 1 was waiting for a bone marrow transplant. CMV retinitis presented with a median of 61 months after a lymphoma diagnosis. 

Patients were treated with 900 mg of oral valganciclovir every 12 hours for up to 3 weeks and then a maintenance dose of 450 mg every 12 hours. All but a single patient received an additional 2.4 mg of intravitreal foscarnet injection prior to oral treatment. Positive response to treatment was defined as an improvement in the retinitis and a 2-step decrease or decreased to grade 0 in inflammation in the anterior chamber and/or vitreous.

All patients demonstrated improvements in their inflammatory findings. Of the 6 managed with supplemental intravitreal foscarnet injection, 5 required only a single injection. There was no significant change in visual acuities from baseline to the last follow-up visit.

“To our knowledge, this report included the largest case series on CMV retinitis in patients with systemic lymphoma published at date,” the researchers report.