Abstract
Purpose To describe the frequency of anterior uveitis and ocular hypotony in cidofovir-treated patients with acquired immune deficiency syndrome (AIDS)-related cytomegalovirus (CMV) retinitis.
Methods A retrospective review was performed of all patients with AIDS-related CMV retinitis during a 12-month period. The CMV retinitis activity, concurrent illnesses and medications, and CD4+ lymphocyte count were recorded in addition to the degree of anterior chamber inflammation and intraocular pressure at each visit. The frequency of uveitis and ocular hypotony in cidofovir-treated patients was determined and the possible influence of other ocular and systemic factors considered.
Results Eight of 9 patients on cidofovir developed anterior uveitis. The cellular anterior chamber activity resolved with topical corticosteroid administration in all eyes with uveitis but significant flare persisted despite topical steroids in 3 patients. Posterior synechiae responded poorly to topical mydriatic therapy, resulting in inadequate mydriasis which significantly limited the fundal view. One patient developed a visually significant unilateral hypotonous maculopathy.
Conclusions Patients treated with intravenous cidofovir for AIDS-related CMV retinitis are at significant risk of ocular adverse effects. Prompt treatment with topical corticosteroids and mydriatics may control uveitis and in some cases cidofovir treatment may be cautiously continued. In the event of ocular hypotony cidofovir should be discontinued in favour of an alternative anti-cytomegaloviral agent.
Similar content being viewed by others
Article PDF
References
Hoover DR, Saah AJ, Bacellar H, Phair J, Detels R, Anderson R, et al. Clinical manifestations of AIDS in the era of Pneumocystis prophylaxis. Multicenter AIDS Cohort Study. N Engl J Med 1993;329:1922–6.
Jabs DA . Cidofovir [review]. Arch Ophthalmol 1997;115:785–6.
Katlama C . Consequences for the management of cytomegalovirus. AIDS 1996;10(Suppl 1):S43–6.
Foscarnet-Ganciclovir Cytomegalovirus Retinitis Trial. 4. Visual outcomes. Studies of ocular complications of AIDS Research Group, in collaboration with the AIDS Clinical Trials Group. Ophthalmology 1994;101:1250–61.
Collaborative DHPG Treatment Study Group. Treatment of serious cytomegalovirus infections with 9-(l,3-dihydroxy-2-propoxymethyl)guanine in patients with AIDS and other immunodeficiencies. N Engl J Med 1986;3:801–5.
Fanning MM, Read SE, Benson M, Vass S, Rachilis A, Kozousek V, et al. Foscarnet therapy of cytomegalovirus retinitis in AIDS. J Acquir Immune Defic Syndr Hum Retroviral Syndr 1990;3:472–9.
Cochereau-Massin I, Lehaong P, Lautier-Frau M, Zazoun L, Marcel P, Robinet M, et al. Efficacy and tolerance of intravitreal ganciclovir in cytomegalovirus retinitis in acquired immune deficiency syndrome. Ophthalmology 1991;98:1348–53.
Martin DF, Parks DJ, Mellow SD, Ferris FL, Walton RC, Remaley MA, et al. Treatment of cytomegalovirus retinitis with an intraocular sustained-release ganciclovir implant: a randomised controlled clinical trial. Arch Ophthalmol 1994;112:1531–9.
Lalezari JP, Stagg RJ, Kuppermann BD, Holland GN, Kramer F, Ives DV, et al. Intravenous cidofovir for peripheral cytomegalovirus retinitis in patients with AIDS: a randomised, controlled trial. Ann Intern Med 1997;126:257–63.
Rahhal FM, Arevalo JF, Munguia D, Taskintuna I, Chavez de la Paz E, Azen SP, et al. Intravitreal cidofovir for the maintenance treatment of cytomegalovirus retinitis. Ophthalmology 1996;103:1078–83.
Banker AS, Arevalo JF, Munguia D, Rahhal FM, Ishimoto B, Berry C, et al. Intraocular pressure and aqueous humour dynamics in patients with AIDS treated with intravitreal cidofovir (HPMPC) for cytomegalovirus retinitis. Am J Ophthalmol 1997;124:168–80.
Chavez-de la Paz E, Arevalo JF, Kirsch LS, Munguia D, Rahhal FM, De Clercq E, et al. Anterior nongranulomatous uveitis after intravitreal HPMPC (cidofovir) for the treatment of cytomegalovirus retinitis: analysis and prevention. Ophthalmology 1997;104:539–44.
Kirsch LS, Arevalo JF, Chavez de la Paz E, Munguia D, de Clercq E, Freeman WR . Intravitreal cidofovir (HPMPC) treatment of cytomegalovirus retinitis in patients with acquired immune deficiency syndrome. Ophthalmology 1995;102:533–42.
Taskintuna I, Rahhal FM, Arevalo JF, Munguia D, Banker AS, De Clercq E, et al. Low-dose intravitreal cidofovir (HPMPC) therapy of cytomegalovirus retinitis in patients with acquired immune deficiency syndrome. Ophthalmology 1997;104:1049–57.
Davis JL, Taskintuna I, Freeman WR, Weinberg DV, Feuer WJ, Leonard RE . Iritis and hypotony after treatment with intravenous cidofovir for cytomegalovirus retinitis [see comments]. Arch Ophthalmol 1997;115:733–7.
Friedberg DN . Hypotony and visual loss with intravenous cidofovir treatment of cytomegalovirus retinitis. Arch Ophthalmol 1997;115:801–2.
Kelleher P, Helbert M, Sweeney J, Anderson J, Parkin J, Pinching A . Uveitis associated with rifabutin and macrolide therapy for Mycobacterium avium intracellular infection in AIDS patients. Genitourin Med 1996;72:419–21.
Tseng AL, Walmsley SL . Rifabutin-associated uveitis. Ann Pharmacother 1995;29:1149–55.
Walter KA, Coulter VL, Palay DA, Taravella MJ, Grossniklaus HE, Edelhauser HF . Corneal endothelial deposits in patients with cytomegalovirus retinitis. Am J Ophthalmol 1996;121:391–6.
Taskintuna I, Banker AS, Rao NA, Wiley CA, Flores-Aguilar M, Munguia D, et al. An animal model for cidofovir (HPMPC) toxicity: intraocular pressure and histopathologic effects. Exp Eye Res 1997;64:795–806.
Studies of Ocular Complications of AIDS Research Group in collaboration with the AIDS Clinical Trials Group. Parenteral cidofovir for cytomegalovirus retinitis in patients with AIDS: the HPMPC peripheral cytomegalovirus retinitis trial. A randomised, controlled trial. Ann Intern Med 1997;126:264–74.
Arevalo J, Munguia D, Faber D, et al. Correlation between intraocular pressure and CD4+ T-lymphocyte counts in patients with human immunodeficiency virus with and without cytomegalovirus retinitis. Am J Ophthalmol 1996;122:91–6.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Bainbridge, J., Raina, J., Shah, S. et al. Ocular complications of intravenous cidofovir for cytomegalovirus retinitis in patients with AIDS. Eye 13, 353–356 (1999). https://doi.org/10.1038/eye.1999.89
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1038/eye.1999.89