Owing to its cost-effectiveness, intravitreal ganciclovir
injection is the current standard treatment in the SA public sector for active CMV retinitis infection,  even though systemic ganciclovir
or valganciclovir therapy is standard of care in other countries as these drugs assist in the prevention of systemic dissemination and improving survival.
While topical ganciclovir
is approved for use in acute herpetic keratitis, its efficacy has also been demonstrated against cytomegalovirus and some strains of adenovirus, while systemic administration of ganciclovir
is effective against HIV (16) Although there are no previous studies showing that topical ganciclovir
is effective against MC, we initially administered it to both of our patients considering its broad-spectrum antiviral activity, but no improvement was achieved.
Valganciclovir is an orally bioavailable prodrug metabolized rapidly to ganciclovir
in intestinal tissues and the liver (Woo & Robinson, 2016).
Universal prophylaxis with intravenous ganciclovir
(5mg/kg) was implemented according to previous institutional protocol: P.
Cytomegalovirus pp65 antigenemia-guided early treatment with ganciclovir
at engraftment after allogeneic marrow transplantation: a randomized double-blind study.
The infection did not respond to ganciclovir
or foscarnet, and CMV viral load was rising.
A protein kinase homologue controls phosphorylation of ganciclovir
in human cytomegalovirus-infected cells.
Remission of HHV-8 and HIV associated multicentric Castleman disease with ganciclovir
Treatment is with intravitreal ganciclovir
injections and oral acyclovir, but once retinal detachment occurs, surgery is needed.
Prevention of primary cytomegalovirus disease in organ transplant recipients with oral ganciclovir
or oral acyclovir prophylaxis.
All of these patients recovered rapidly with ganciclovir
or valganciclovir treatment.
CMV has been called the 'neglected disease of the AIDS pandemic', in part because of limited access to treatment, especially in the developing world, where localised intra-ocular ganciclovir
implants and systemic oral valganciclovir are unavailable or too costly.