ArticleJournal of Yeungnam medical science2026
Efficacy of high-dose vs. low-dose intravitreal ganciclovir for cytomegalovirus retinitis: a systematic review and meta-analysis.
Article in Journal of Yeungnam medical science, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIntravitreal ganciclovir is widely used to achieve effective local antiviral concentrations for cytomegalovirus (CMV) retinitis; however, to our knowledge, standardized dosing strategies have not been established, and the reported regimens vary considerably across studies. In this study, we evaluated dose-dependent treatment outcomes of intravitreal ganciclovir for CMV retinitis.
methodsThe PubMed, Embase, Cochrane, and Scopus databases were searched through November 2025. Eligible studies included intravitreal ganciclovir monotherapy, with or without systemic antiviral therapy. Cumulative first-week intravitreal dose was calculated and classified as low dose (<4,000 µg) or high dose (≥4,000 µg). The pooled proportions for resolution, visual outcomes, recurrence, and retinal detachment were estimated using a random-effects model.
resultsEighteen studies comprising 1132 eyes were included across all outcomes. The pooled proportion of anatomical resolution was 89% (95% confidence interval, 0.77-0.95), and 74% of eyes maintained stable or improved vision. Recurrence and retinal detachment occurred in 12% and 9% of the eyes, respectively. High-dose regimens achieved a significantly higher resolution than low-dose regimens (94% vs. 73%, p=0.019). Visual outcomes did not differ according to dose (77% vs. 73%, p=0.646). Recurrence also showed no dose-dependent difference (14% vs. 8%, p=0.654) and was observed predominantly in patients before the introduction of highly active antiretroviral therapy. The retinal detachment rates were similar (9% vs. 10%, p=0.780).
conclusionInitial intravitreal dosing at ≥4,000 µg within the first week achieved better retinitis resolution, supporting the benefit of a higher local ganciclovir concentration in the treatment of CMV retinitis.
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