Cases should be confirmed by an experienced ophthalmologist, although treatment should not be delayed in suspected cases. Foscarnet has equivalent efficacy but is less well tolerated and requires administration by infusion pump. Cidofovir remains investigational in Canada and has mainly been used as salvage therapy. This is the most effective form of treatment but involves major ocular surgery, and may be associated with complications including endophthalmitis, and retinal detachment.
Vision transiently worsens during the first few weeks after the implant is inserted.
A disadvantage of local treatment is the greater risk of developing disease which is extraocular or involving the contralateral eye. Less aggressive or no maintenance therapy may be appropriate for selected patients with good virologic and immunologic responses to combination antiretroviral therapy. This approach has the advantage of preventing disease from developing at other sites, but is more expensive and may be associated with more adverse effects. One litre of saline should be infused during the 1-2 hour period immediately before the cidofovir infusion which is then given in 100 mL normal saline. Patients who are able to tolerate an additional fluid load should be given a second litre of normal saline either during or immediately after the cidofovir infusion and run over 1-3 hours.