What is the recommended treatment for CMV retinitis?
CMV retinitis should be managed in cooperation with an experienced ophthalmologist. For patients with CMV retinitis that is immediately sight-threatening (central lesions approaching or involving the optic nerve or the fovea) systemic therapy with either IV ganciclovir or oral valganciclovir is the preferred initial treatment; many experts would also recommend surgical treatment with a ganciclovir intraocular implant (see Table 9-4). IV ganciclovir or oral valganciclovir is administered in an acute “induction” dose for 14-21 days, followed by a once-a-day chronic maintenance therapy dose. This approach is superior to other alternatives for preventing or delaying disease progression and provides systemic treatment to prevent other organ system involvement. If effective ART is not administered or patients remain immunosuppressed, the ocular implant should be replaced every 7-8 months. For patients with peripheral CMV retinitis that is not immediately sight-threatening, oral valganciclovi
