The assessement of the safety of serial intravitreal injections of antiviral drugs with intraocular ftuid sampling for cytomegalovirus retinitis in pediatric recipients of allogeneic hematopoietic stem cell transplantation

Monitoring of viral “load” in intraocular fluid and intravitreal injections (IVIs) of antiviral drugs along with systemic antiviral therapy is an effective measure of control of cytomegalovirus retinitis in hematopoietic stem cell (HSC) recipients, but the safety of this method in children has not been studied. Complications of serial intraocular fluid sampling and IVIs of antiviral drugs (pain, hemorrhage, corneal erosion) were evaluated after 585 IVIs in 48 pediatric HSC recipients. The study was approved by the Independent Ethics Committee and the Scientific Council of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of Ministry of Healthcare of the Russian Federation. Pain was assessed using the visual analog pain scale, and ophthalmoscopy was performed before the IVI and the day after it to detect other complications (1174 exams). Pain developing immediately after the IVI was shown to be an almost inevitable consequence of the procedure (43 (96%) of 45 patients; after 92% of injections) and was independent of the drug administered (ganciclovir vs foscarnet) or its concentration. The most common complication was subconjunctival hemorrhage of varying severity (16%), with rare complications represented by hyphema (0.3%) and corneal erosion. Serial IVIs of antiviral drugs with intraocular fluid sampling is an effective and safe method of treatment of cytomegalovirus retinitis in pediatric recipients of allogeneic HSC, but it inevitably causes post-manipulation pain requiring analgesia.