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OBJECTIVE To evaluate the incidence and the prognosis of retinal detachment in CMV retinitis in AIDS. To test intravitreal injections of ganciclovir into the vitreal cavity filled with silicone. METHODS Among 136 eyes with CMV retinitis, 15 (11%) had retinal detachment. Ten eyes underwent intraocular surgery with injection of silicone oil, one extraocular surgery and four eyes were not operated. Later, four eyes filled with silicone received intravitreal injections of ganciclovir. RESULTS At 2 months, the retina was flat in all the operated eyes, with a visual acuity improved or stabilized in 8 cases (73%). Conversely, visual acuity was lost in all the unoperated eyes. The 14 intravitreal injections of ganciclovir performed in four eyes (which received 2, 3, 3 or 6 injections, respectively) were well tolerated. CONCLUSIONS Surgery of retinal detachment in CMV retinitis usually allows the conservation of ambulatory visual acuity. Its indications must be discussed together with the patient, the ophthalmologist and the physician. Intravitreal injections of ganciclovir in vitreal cavity filled with silicone oil are possible.
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