E. Chavezdelapaz et al., ANTERIOR NONGRANULOMATOUS UVEITIS AFTER INTRAVITREAL HPMPC (CIDOFOVIR) FOR THE TREATMENT OF CYTOMEGALOVIRUS RETINITIS - ANALYSIS AND PREVENTION, Ophthalmology, 104(3), 1997, pp. 539-544
Background and Objective: The authors characterize and analyze the inc
idence of a previously reported mild anterior nongranulomatous uveitis
associated with intravitreal injections of S)-1-(3-hydroxy-2-phosphon
ylmethoxypropyl)cytosine (HPMPC), also termed cidofovir (Vistide, Gile
ad Sciences, Foster City, CA). This is an acyclic nucleoside phosphona
te analogue with a potent anticytomegalovirus effect. The authors also
analyzed the effects of probenecid therapy, as well as prophylaxis wi
th probenecid plus topical corticosteroids and cycloplegics on the cou
rse and outcome of the uveitis. Methods: Prospective case series from
a tertiary referral center, which included 46 consecutive patients wit
h acquired immune deficiency syndrome (AIDS) and cytomegalovirus (CMV)
retinitis. There was a total of 130 injections in 69 eyes treated wit
h 20 mu g of intravitreal HPMPC. Forty-one patients (119 injections) r
eceived oral probenecid, 5 patients (11 injections) did not, and 21 pa
tients (53 injections) received topical corticosteroids and cycloplegi
cs as an adjuvant to probenecid in the prophylaxis of iritis. Results:
Mild to moderate nongranulomatous iritis was seen in 26% of patients
after their first injection (n = 12). Patients receiving probenecid pr
ophylaxis after first injection had a significantly lower frequency of
iritis versus patients who did not receive probenecid at the time of
first injection (P = 0.0089). In contrast, treatment with topical cort
icosteroid and cycloplegics after injection did not statistically sign
ificantly affect the frequency of iritis in patients (P = 0.44). The d
evelopment of iritis after a second injection of HPMPC was more likely
if it had occurred after the initial injection (P = 0.015; Fisher's e
xact test). All cases of iritis were treated with topical corticostero
ids and cycloplegics, and there was no permanent impairment of vision
secondary to iritis after HPMPC injection in any eyes. Conclusions: An
terior uveitis was seen in 26% of patients after first-time HPMPC inje
ction. Concomitant use of probenecid appears to decrease the frequency
of the iritis from 71% to 18% in patients with AIDS and CMV retinitis
after the first intravitreal injection of HPMPC. Topical corticostero
id administration after injection (before iritis) was ineffective in p
reventing iritis treatment with topical corticosteroids and cycloplegi
cs resulted in resolution of all iritis cases.