Ocular complications of intravenous cidofovir for cytomegalovirus retinitis in patients with AIDS

Purpose To describe the frequency of anterior uveitis and ocular hypotony i n cidofovir-treated patients with acquired immune deficiency syndrome (AIDS )-related cytomegalovirus (CMV) retinitis. Methods A retrospective review was performed of all patients with AIDS-rela ted CMV retinitis during a 12-month period. The CMV retinitis activity, con current illnesses and medications, and CD4(+) lymphocyte count were recorde d in addition to the degree of anterior chamber inflammation and intraocula r pressure at each visit. The frequency of uveitis and ocular hypotony in c idofovir-treated patients was determined and the possible influence of othe r ocular and systemic factors considered. Results Eight of 9 patients on cidofovir developed anterior uveitis. The ce llular anterior chamber activity resolved with topical corticosteroid admin istration in all eyes with uveitis but significant flare persisted despite topical steroids in 3 patients. Posterior synechiae responded poorly to top ical mydriatic therapy, resulting in inadequate mydriasis which significant ly limited the fundal view. One patient developed a visually significant un ilateral hypotonous maculopathy. Conclusions Patients treated with intravenous cidofovir for AIDS-related CM V retinitis are at significant risk of ocular adverse effects. Prompt treat ment with topical corticosteroids and mydriatics may control uveitis and in some cases cidofovir treatment may be cautiously continued. In the event o f ocular hypotony cidofovir should be discontinued in favour of an alternat ive anti-cytomegaloviral agent.