[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-456575-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-456575-en":130},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","presumed-macular-toxicity-of-high-dose-intravitreal-ganciclovir","Presumed macular toxicity of high-dose intravitreal ganciclovir","","A 56-year-old man with bilateral cytomegalovirus retinitis received oral valganciclovir plus intravitreal ganciclovir twice weekly for 2 weeks, then weekly. After escalating intravitreal dosing from 2 mg/0.08 mL to 4 mg/0.08 mL due to suboptimal response, he developed worsening vision. OCT showed neurosensory detachment with foveal involvement and hyperreflectivity, prompting further escalation to 6 mg/0.08 mL. Vision declined immediately after injection, and OCT revealed foveal ellipsoid zone disruption and a hyperreflective band with NSD, leading to discontinuation of intravitreal therapy and continuation of oral valganciclovir. At 1 month, vision and OCT findings improved, supporting presumed macular toxicity from high-dose intravitreal ganciclovir.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/presumed-macular-toxicity-of-high-dose-intravitreal-ganciclovir/456575/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/presumed-macular-toxicity-of-high-dose-intravitreal-ganciclovir/456575.png","ImageObject",300,407,{"name":42,"@type":43},"mieayamfan","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-30","2026-09-30",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",8,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What was the patient’s initial treatment for bilateral cytomegalovirus retinitis?","Question",{"text":63,"@type":64},"He started oral valganciclovir and intravitreal ganciclovir twice weekly for the first 2 weeks, with intravitreal dosing beginning at 2 mg/0.08 mL in the first week.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"Why was intravitreal ganciclovir dose increased during therapy?",{"text":68,"@type":64},"The response was suboptimal, and there was concern for risk of foveal involvement, leading to escalation from 2 mg/0.08 mL to 4 mg/0.08 mL, and later to 6 mg/0.08 mL when foveal involvement was suspected.",{"name":70,"@type":61,"acceptedAnswer":71},"How did clinicians respond after signs suggested macular toxicity?",{"text":72,"@type":64},"Intravitreal therapy was stopped and oral valganciclovir was continued; at 1-month follow-up, the patient’s vision and OCT findings improved with resolution of hyperreflectivity and NSD.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},456575,1791252718,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,114,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":111,"show_sort_weight":112,"slug":113},"Research & Report",30,"research-report",{"id":115,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},9,"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":97,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":33,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":123,"preview_page_count":4},962090893677,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","| Access this article online |\n| --- |\n| Quick Response Code: |\n| |\n| Website:\u003Cbr>[http://journals.lww.com/TJOP](http://journals.lww.com/TJOP) |\n| DOI:\u003Cbr>10.4103/tjo.TJO-D-23-00114 |\n\nDepartment of Vitreo‑Retina, Sankara Eye Hospital, Shimoga, Karnataka, India  \n*Address for correspondence:  \nDr. Pradeep Sagar, Department of  \nVitreo-Retina, Sankara Eye Hospital, Harakere, Shimoga-577 202, Karnataka, India.  \nE-mail: pradeepsagarbk@ [gmail.com](gmail.com)  \nSubmission: 30-07-2023  \nAccepted: 18-10-2023  \nPublished: 24-04-2024  \nCase Report  \nTaiwan J Ophthalmol 2025;15:659‑662  \nPresumed macular toxicity of high‑dose intravitreal ganciclovir  \nShubhra Sweta, Parvathy Prabhakaran, Chaithra Kakunje, Pradeep Sagar*, Suchitra Biswal, H. N. Ravishankar  \nAbstract:  \nA 56‑year‑old male with bilateral cytomegalovirus retinitis was initiated on oral valganciclovir and intravitreal ganciclovir injection twice a week in first 2 weeks and once a week in subsequent weeks. An intravitreal dose of 2 mg/0.08 mL was administered in the 1st week. Considering the suboptimal response, the dose of intravitreal ganciclovir was increased to 4 mg/0.08 mL. After 4 weeks of therapy (four doses of 4‑mg ganciclovir), the patient complained of worsening of vision. Fundus examination showed resolving retinitis, but the optical coherence tomography (OCT) showed neurosensory detachment (NSD) at the fovea in both eyes with inner retinal hyperreflectivity in the right eye. Considering the possibility of retinitis involving fovea, a higher dose of intravitreal ganciclovir (6 mg/0.08 mL) was administered. The patient reported further worsening of vision immediately after removing the eye patch 2 hr following the injection. OCT showed a full‑thickness hyperreflective vertical band with ellipsoid zone disruption at the fovea and inner retinal hyperreflectivity in the right eye. Hyperreflective vertical band with NSD was seen in the left eye. A possibility of macular toxicity due to intravitreal ganciclovir was considered. Intravitreal therapy was stopped and oral valganciclovir was continued. At 1‑month follow‑up, the patient reported improvement in vision. The hyperreflectivity and NSD were resolved at month follow‑up. Although higher doses of ganciclovirup to 6 mg have been used in the past, it would be better to avoid higher doses considering the development of presumed drug toxicity in our case following the use of 4 mg and 6 mg.  \nKeywords:  \nCase report, cytomegalovirus retinitis, intravitreal ganciclovir, macular toxicity  \nIntroduction  \nCytomegalovirus (CMV) retinitis is the  \nmost common ocular complication inpatients with human immunodeficiency virus (HIV) and CMV coinfection, developing in approximately half of these patients. It is also the major cause of blindness among HIV‑infected patients characterized by acute and progressive retinitis resulting in areas of necrosis and eventually scarring of the central and peripheral retina . [1] The treatment includes a wide variety of antiviral drugs, of which ganciclovir is the most commonly used drug which can be administered systemically or intravitreally. Here, we report a case of bilateral CMV  \nThis is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercialNoDerivatives 4.0 License (CC BY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.  \nFor reprints [contact:](contact: WKHLRPMedknow_reprints@wolterskluwer.com)[ WKHLRPMedknow_reprints@wolterskluwer.com](contact: WKHLRPMedknow_reprints@wolterskluwer.com)  \nretinitis with presumed macular toxicity of high‑dose intravitreal ganciclovir.  \nCase Presentation  \nA 56‑year‑old male presented to us with complaints of diminution of vision in both eyes for 5 days. He was a known case of Type 2 diabetes mellitus and hypertension for 8 years and was on treatment. He was diagnosed ","cbCaigyANwXw18b6","https://ap.wps.com/l/cbCaigyANwXw18b6","pdf",1110699,"English","# Case Report\n## Abstract\n## Introduction\n## Case Presentation\n## Treatment and Follow-up","[{\"question\":\"What was the patient’s initial treatment for bilateral cytomegalovirus retinitis?\",\"answer\":\"He started oral valganciclovir and intravitreal ganciclovir twice weekly for the first 2 weeks, with intravitreal dosing beginning at 2 mg/0.08 mL in the first week.\"},{\"question\":\"Why was intravitreal ganciclovir dose increased during therapy?\",\"answer\":\"The response was suboptimal, and there was concern for risk of foveal involvement, leading to escalation from 2 mg/0.08 mL to 4 mg/0.08 mL, and later to 6 mg/0.08 mL when foveal involvement was suspected.\"},{\"question\":\"How did clinicians respond after signs suggested macular toxicity?\",\"answer\":\"Intravitreal therapy was stopped and oral valganciclovir was continued; at 1-month follow-up, the patient’s vision and OCT findings improved with resolution of hyperreflectivity and NSD.\"}]","Presumed macular toxicity of high-dose intravitreal ganciclovir | PDF",1790746419]