IRITIS AND HYPOTONY AFTER TREATMENT WITH INTRAVENOUS CIDOFOVIR FOR CYTOMEGALOVIRUS RETINITIS

Objective: To describe intraocular inflammation due to treatment with intravenous cidofovir dihydrate for cytomegalovirus retinitis. Design: Retrospective cohort. Setting: Three university outpatient ophthalmol ogy clinics. Patients: All patients treated with intravenous cidofovir therapy before October 31, 1996. Intervention: Treatment with intrave nous cidofovir was given according to standardized protocols. Intraocu lar inflammation was treated according to the best medical judgment. M ain Outcome Measures: The presence of new intraocular inflammation, th e severity of inflammation, visual acuity, and intraocular pressure. R esults: 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 retini tis (P = .03), to be diabetic (P = .05), or to be receiving protease i nhibitors (P < .001). Four patients and 15 control subjects had also t aken 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 (+/- S D) of 4.2 +/- 1.6 doses of cidofovir. Six eyes of 4 patients had hypot ony. Five eyes of 5 patients had a persistent decrease in visual acuit y of at least 2 Snellen lines. Conclusions: Acute intraocular inflamma tion may occur with or without hypotony after intravenous cidofovir th erapy, similar to the reactions seen after intravitreous administratio n. Although the manifestations may be severe, they are manageable with topical corticosteroid therapy in most cases. Cidofovir therapy can b e continued in some patients if medical necessity warrants, but recurr ent inflammation or permanent hypotony may occur.