Anterior nongranulomatous uveitis after intravitreal HPMPC (cidofovir) for the treatment of cytomegalovirus retinitis. Analysis and prevention.
OBJECTIVE
The authors characterize and analyze the incidence of a previously reported mild anterior nongranulomatous uveitis associated with intravitreal injections of (S)-1-(3-hydroxy-2-phosphonylmethoxypropyl)cytosine (HPMPC), also termed cidofovir (Vistide, Gilead Sciences, Foster City, CA). This is an acyclic nucleoside phosphonate analogue with a potent anticytomegalovirus effect. The authors also analyzed the effects of probenecid therapy, as well as prophylaxis with probenecid plus topical corticosteroids and cycloplegics on the course and outcome of the uveitis.


METHODS
Prospective case series from a tertiary referral center, which included 46 consecutive patients with acquired immune deficiency syndrome (AIDS) and cytomegalovirus (CMV) retinitis. There was a total of 130 injections in 69 eyes treated with 20 micrograms of intravitreal HPMPC. Forty-one patients (119 injections) received oral probenecid, 5 patients (11 injections) did not, and 21 patients (53 injections) received topical corticosteroids and cycloplegics 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 prophylaxis 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 corticosteroid and cycloplegics after injection did not statistically significantly affect the frequency of iritis in patients (P = 0.44). The development of iritis after a second injection of HPMPC was more likely if it had occurred after the initial injection (P = 0.015; Fisher's exact test). All cases of iritis were treated with topical corticosteroids and cycloplegics, and there was no permanent impairment of vision secondary to iritis after HPMPC injection in any eyes.


CONCLUSIONS
Anterior uveitis was seen in 26% of patients after first-time HPMPC injection. 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 corticosteroid administration after injection (before iritis) was ineffective in preventing iritis treatment with topical corticosteroids and cycloplegics resulted in resolution of all iritis cases.
Chavez-de la Paz
E
E
Department of Ophthalmology, Shiley Eye Center, University of California San Diego, La Jolla 92093-0946, USA.
Arevalo
J F
JF
Kirsch
L S
LS
Munguia
D
D
Rahhal
F M
FM
De Clercq
E
E
Freeman
W R
WR
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000473:pathology; D000998:Antiviral Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000077404:Cidofovir; D017726:Cytomegalovirus Retinitis / Q000188:drug therapy* / Q000473:pathology; D003596:Cytosine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use; D006099:Granuloma; D006801:Humans; D015994:Incidence; D007267:Injections; D007500:Iritis / Q000139:chemically induced* / Q000473:pathology / Q000517:prevention & control*; D009184:Mydriatics / Q000627:therapeutic use; D063065:Organophosphonates; D009943:Organophosphorus Compounds / Q000009:adverse effects* / Q000627:therapeutic use; D011339:Probenecid / Q000627:therapeutic use; D011446:Prospective Studies; D014528:Uricosuric Agents / Q000627:therapeutic use; D014822:Vitreous Body
D000998:Antiviral Agents; D005938:Glucocorticoids; D009184:Mydriatics; D063065:Organophosphonates; D009943:Organophosphorus Compounds; D014528:Uricosuric Agents; D003596:Cytosine; D000077404:Cidofovir; D011339:Probenecid