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The objective of treatment is to prevent progression of the disease, which can lead to blindness. Therapy must be continued indefinitely, or until blindness occurs. Intravenous ganciclovir, foscarnet, and cidofovir have all been shown to improve CMV retinitis.
Once the patient is improving, the drugs can sometimes be taken orally instead. Sometimes, however, CMV is resistant to these drugs. Also, ganciclovir can deplete white blood cells, and cidofovir and foscarnet can cause kidney damage.
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Ganciclovir and foscarnet can also be given as intravitreal implants. Intravitreal implants are small capsules of medications surgically inserted into the eye. They deliver a very high dose of medication to the eye.
Oral anti-CMV agents should be taken along with the implants, which must be changed every eight months. These implants have been shown to be beneficial in reducing progression of CMV retinitis.
Fomivirsen, a drug recently approved by the FDA, is injected directly into the eye.
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