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Background: The Foscarnet-Ganciclovir Cytomegalovirus Retinitis Trial compared the use of either ganciclovir or foscarnet for the initial treatment of cytomegalovirus retinitis in patients with the acquired immunodeficiency syndrome. We previously reported that patients treated with foscarnet lived longer but were more likely to have their treatment switched, the latter suggesting foscarnet may not have been as well tolerated as ganciclovir. This study compared the morbidity and toxic reactions reported during the trial. Methods: Two hundred thirty-four patients with the acquired immunodeficiency syndrome and previously untreated cytomegalovirus retinitis at 11 university centers were randomly assigned to receive intravenously either foscarnet (n=107) or ganciclovir (n=127). Medical histories, laboratory tests, and drug treatment histories during the first 6 months of treatment were analyzed. Results: Neutropenia was more common in patients assigned to ganciclovir than to foscarnet (34% vs 14%;P=.001). Patients assigned to foscarnet reported more infusion-related symptoms (58% vs 24%;P .001); they also experienced a trend toward more nephrotoxic effects (13% vs 6%;P=.082) and electrolyte abnormalities. The incidence of seizures was similar in both groups (foscarnet, 12%; ganciclovir, 9%;P=.511). Patients assigned to foscarnet were more likely to be switched to the alternative treatment (foscarnet to ganciclovir, 46%; ganciclovir to foscarnet, 11%;P Conclusions: Compared with ganciclovir, the use of foscarnet was more frequently limited by the occurrence of toxic reactions. However, these toxic reactions rarely had long-term sequelae. In light of the previously reported survival benefit seen in patients treated with foscarnet, these data support the use of foscarnet for the initial treatment of cytomegalovirus retinitis. (Arch Intern Med. 1995;155:65-74)

Cytomegalovirus (CMV) retinal infection has become a major cause of morbidity for severely immunocompromised patients with the acquired immunodeficiency syndrome (AIDS). Cytomegalovirus retinitis is currently the leading cause of decreased visual acuity and loss of visual field among American patients with AIDS. In this population, retinal infection by CMV occurs predictably as a late complication when helper T-lymphocyte (CD4) counts drop below 0.05×10 9 /L (50 cells per microliter). 1 Before the AIDS epidemic, CMV was an infrequent cause of retinitis in immunosuppressed patients undergoing organ transplantation and in patients with endstage cancer. 2 We report herein an HIV-negative patient with myasthenia gravis and a normal CD4 count (0.86×10 9 /L) who developed CMV retinitis while being treated with azathioprine. Report of a Case. The patient was a 56-year-old Asian woman who was referred to us with bilateral, increasingly blurred vision of 3 weeks' duration. The patient denied subjective

To the Editor. —Opportunistic intraocular infections caused by a wide variety of pathogens have been described as complications of the acquired immunodeficiency syndrome (AIDS). Candida endophthalmitis, a commonly recognized complication of disseminated candidiasis, is often seen in the setting of neutropenia or impaired neutrophil function, but rarely as the sequela of a deficiency of cell-mediated immunity. We present a case of Candida albicans endophthalmitis in a bisexual male with AIDS and no history of drug abuse. Report of a Case. —A 50-year-old Hispanic man with AIDS was admitted for evaluation of chronic dermatitis of unknown origin, anemia, and low-grade fever. Shortly after admission, an ophthal

To the Editor. —Treatment of progressive cytomegalovirus (CMV) retinitis with intravitreal injections of ganciclovir has been advocated as an effective and safe form of therapy in patients in whom severe neutropenia precludes adequate intravenous ganciclovir therapy. 1,2 A patient with acquired immunodeficiency syndrome (AIDS) complicated by progressive CMV retinitis of the right eye underwent a course of intravitreal treatment with ganciclovir because of persistent neutropenia resulting from intravenous ganciclovir therapy. During the ninth week of therapy the patient developed a bacterial endophthalmitis that required pars plana vitrectomy and a course of systemic antibiotic therapy. Report of a Case. —A 36-year-old homosexual man was diagnosed as having AIDS in 1987 when he developed Pneumocystis carinii pneumonia. At this time he was found to have CMV retinitis of the right eye, which was treated with an initial induction course of ganciclovir followed by maintenance therapy. The progression of the retinitis was arrested