Thus any advances in this area are to be welcomed. The use of sustained-release ganciclovir, delivered as local therapy by surgical implantation in the pars plana, is described in the article by Musch and colleagues. In this study, the median time to progression of retinitis in treated eyes was about 6 to 8 months, suggesting effective control for as long as the drug is released.
Surgical implantation is also well tolerated.
However, CMV disease should be regarded as a systemic infection and implants are local therapy. The risk of retinitis in the other eye or visceral cytomegalovirus infection is substantially greater with implant therapy, presumably because subclinical CMV disease elsewhere, or CMV viremia, is unchecked without additional systemic treatment. The key issue now is to identify which patients are best treated with such an approach. Because of their effectiveness, ganciclovir implants should be considered the treatment of choice for patients with sight-threatening retinitis. Patients should also receive aggressive management of their HIV disease, since it may be possible to completely arrest the progression of CMV retinitis, and obviate the need for further implants later.