Iritis and Hypotony After Treatment With Intravenous Cidofovir for Cytomegalovirus Retinitis
Janet L. Davis, MD;
Ibrahim Taskintuna, MD;
William R. Freeman, MD;
David V. Weinberg, MD;
William J. Feuer, MS;
Robert E. Leonard, MD
Arch Ophthalmol. 1997;115(6):733-737.
Abstract
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Objective
To describe intraocular inflammation due to treatment with intravenous cidofovir dihydrate for cytomegalovirus retinitis.
Design
Retrospective cohort.
Setting
Three university outpatient ophthalmology clinics.
Patients
All patients treated with intravenous cidofovir therapy before October 31, 1996.
Intervention
Treatment with intravenous cidofovir was given according to standardized protocols. Intraocular inflammation was treated according to the best medical judgment.
Main Outcome Measures
The presence of new intraocular inflammation, the severity of inflammation, visual acuity, and intraocular pressure.
Results
Eleven cases of iritis (26%) occurred among 43 patients. In 6 cases, the iritis was bilateral. Patients who experienced iritis were more likely to have been previously treated for cytomegalovirus retinitis (P=.03), to be diabetic (P=.05), or to be receiving protease inhibitors (P<.001). Four patients and 15 control subjects had also taken rifabutin (P=.70). The onset of iritis occurred at a mean (±SD) of 4.9±1.8 days after a cidofovir dose and after a mean (±SD) of 4.2±1.6 doses of cidofovir. Six eyes of 4 patients had hypotony. Five eyes of 5 patients had a persistent decrease in visual acuity of at least 2 Snellen lines.
Conclusions
Acute intraocular inflammation may occur with or without hypotony after intravenous cidofovir therapy, similar to the reactions seen after intravitreous administration. Although the manifestations may be severe, they are manageable with topical corticosteroid therapy in most cases. Cidofovir therapy can be continued in some patients if medical necessity warrants, but recurrent inflammation or permanent hypotony may occur.
Author Affiliations
From the Departments of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Fla (Drs Davis and Leonard and Mr Feuer); Shiley Eye Center, University of California, San Diego (Drs Taskintuna and Freeman); and Northwestern University Medical School, Chicago, Ill (Dr Weinberg).
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