以玻璃體內注射Ganciclovir治療愛滋病患之巨細胞病毒網膜炎―病例報告

Intravitreal Ganciclovir Injection for Unilateral Cytomegalovirus Retinitis in a Patient with Aids

楊長豪(Chang-Hao Yang) ； 許慧娟(Hui-Chuan Hsu) ； 劉寬鎔(Kwan-Rong Liu) ； 張上淳(Shan-Chwen Chang) ； 沈銘鏡(Ming-Ching Shen)

《中華民國眼科醫學會雜誌》 33卷3期 (1994/09) Pp. 409-414

https://doi.org/10.30048/ACTASOS.199409.0018

摘要

本文報告以玻璃體內注射ganciclovir治療一個愛滋病合併單眼巨細胞病毒網膜炎之病例。病人為一位34歲之男性，被診斷為AIDS有一年，於民國81年7月間產生右眼之巨細胞病毒網膜炎。實驗室檢查有全血球減少，T-helper細胞僅有0.2%。理學檢查其他器官則無明顯之巨細胞病毒感染。病人接受玻璃體內注射ganciclovir200μg/0.1ml治療，每週2次共6週，之後減為一週一次共4週。巨細胞病毒網膜炎在治療過程中完全消失，但於停藥數週後復發。總共16次之注射中，無任何併發症產生，亦無網膜毒性出現。病人追踪一年，右眼之巨細胞病毒網膜炎擴及全部網膜，左眼則始終與任何病變。
以玻璃體內注射ganciclovir治療愛滋病患之巨細胞病毒網膜炎可避免因全身性給藥所造成之骨髓抑制。另外在體內其他器官無明顯感染，藥物取得困難及全身性療法仍與法控制之後極部網膜病變亦可使用。但巨細胞病毒常為全身性感染，玻璃體內注射雖可使病灶暫時緩解，但停藥後仍會復發，所以僅可視為輔助性治療，如病人狀況許可仍以全身性ganciclovir治療較佳。

並列摘要

A 34-year-old male patient with acquired immune deficiency syndrome (AIDS) with unilateral cytomegalovirus (CMV) retinitis was treated with intravitreal injection of ganciclovir. Intravitreal injections of ganciclovir 200μg/0.1ml were given in his right eye twice per week for 6 weeks and then weekly for 4 weeks. Totally 16 injections were done and no any complication was found. The therapy was well tolerated by the patient, and there was no evidence of drug toxicity. The CMV retinitis resolved during the treatment course, but reactivated soon after the treatment stopped. The CMV retinitis finally involved whole retina, but the left eye still remained unaffected one year later. Intravitreal injection of ganciclovir may be used as an alternate therapy for CMV retinitis in AIDS patients to avoid the systemic bone marrow suppression, however, the role of intravitreal therapy would be essentialy palliative since the associated systemic CMV infection would not be affected.

並列關鍵字

AIDS ； CMV retinitis ； Intravitreal injection ； ganciclovir