Discussion
AIDS, retinal necrosis, tamponade, IRU, postoperative vision, retinal detachment, CMVR
AIDS, RETINA, RETINAL DETACHMENT, RETINAL BREAKS, ATROPHIC, COMPLICATIONS
In this study, we found that IVI of either low- or intermediate-dose ganciclovir, when combined with systemic ganciclovir therapy, produced favourable visual outcomes for HIV-positive patients with CMVR. However, these outcomes were not maintained at 12 months. Statistical analysis showed that the localization of CMVR in Zone I not only worsened the visual prognosis but also affected the number of IVIs needed. Increasing the concentration of ganciclovir within a certain range did not reduce the number of IVIs. Additionally, the number of IVIs and the rate of complications were significantly lower for lesions in Zone II than for those in Zone I.Several studies have reported favourable clinical outcomes achieved by using various doses of ganciclovir in AIDS patients with CMVR [Previous studies demonstrated that the number of injections needed was positively associated with the initial aqueous CMV DNA load [Zone I lesions were associated with the highest number of complications at the 12-month visit. RRD and IRU were the two major complications (20.9% and 13.4%, respectively). The development of RRD was a consequence of full-thickness retinal necrosis resulting in multiple holes and retinal breaks, which were usually in the atrophic area of the retina. However, we found that even with vitrectomy and silicone oil tamponade, postoperative vision was often limited in CMVR patients with RRD. Some studies have recommended prophylactic laser treatment or early vitrectomy to reduce the risk of retinal detachment [One of the limitations of this study is that we measured the aqueous CMV DNA load only at baseline, which resulted in a lack of quantitative indicators for discontinuing the IVIs. The injections were stopped based only on the change in the fundus, which introduced subjectivity and thus created the potential for bias.