Br J Ophthalmol 1999;83:1153-1158
( October )
Anterior uveitis associated with intravenous cidofovir use in
patients with cytomegalovirus retinitis
Jayakrishna Ambati* a, Kevin B Wynnea, Mary C Angerameb, Michael R Robinson
a
a Department of
Ophthalmology, University of Rochester School of Medicine and
Dentistry, Rochester, NY, USA, b Department of Nursing,
University of Rochester School of Medicine and Dentistry, Rochester,
NY, USA* Current address: Retina Service,
Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA.
Current address:
National Eye Institute/National Institutes of Health, Bethesda, MD
20892, USA.
Correspondence to: Michael R Robinson, MD, 10 Center Drive, National Eye
Institute/National Institutes of Health, Building 10, Room 10N112,
Bethesda, MD 20892, USA.
Accepted for publication 28 May 1999
AIM
Intravenous
cidofovir is used to treat cytomegalovirus (CMV) retinitis, and has
been reported to cause anterior uveitis. Relations were sought between
this complication and patient characteristics that might help predict
its occurrence.
METHODS17 patients
with AIDS and CMV retinitis who were treated with intravenous cidofovir
were identified, and the following data collected in a retrospective
chart review: demographic characteristics, duration of CMV retinitis,
retinal lesion characteristics, dose and duration of cidofovir therapy,
tests of renal function, CD4+ T lymphocyte counts, visual acuity,
intraocular pressure, iris colour, history of diabetes mellitus, and
use of concomitant medications. Case-control analyses were performed to
determine risk factors for developing cidofovir associated uveitis.
RESULTSAnterior
uveitis characterised by pain, ciliary injection, and decreased visual
acuity occurred in 10 patients (59%). Median interval to development
of uveitis was 11 doses of cidofovir. Symptoms developed 4.4 (SD 2.5)
days (median 3.5) after an infusion of cidofovir. Patients who
developed uveitis had a significantly greater rise in CD4+ T lymphocyte
count while receiving cidofovir (68.4 (75.7) ×106/l
versus 5.0 (0.6) ×106/l, (p = 0.04)). By stepwise linear
regression, this factor accounted for 33% (p = 0.03) of the effect of
developing uveitis. Mean follow up time, intraocular pressure decline
during cidofovir therapy, serum creatinine and urine protein
concentrations, and rates of protease inhibitor use were not
significantly different between patients who developed uveitis and
those who did not. Uveitis responded to topical corticosteroids and cycloplegia.
CONCLUSIONAnterior
uveitis in patients receiving intravenous cidofovir therapy may be
related to improving immune function. The uveitis responds to treatment
and may not preclude continuation of cidofovir.
© 1999 by British Journal of Ophthalmology
