Intraocular pressure and aqueous humor dynamics in patients with AIDS treated with intravitreal cidofovir (HPMPC) for cytomegalovirus retinitis.
OBJECTIVE
To evaluate the decrease in intraocular pressure associated with cidofovir (1-[(S)-3-hydroxy-2-(phosphonomethoxy)propyl]cytosine dihydrate; HPMPC) intravitreal injections.


METHODS
We followed up 97 eyes of 63 patients with acquired immunodeficiency syndrome (AIDS) who had cytomegalovirus retinitis and had been treated with up to nine 20-microgram intravitreal cidofovir injections. Measurements were taken at baseline, between 2 and 3 weeks, and at 5 to 6 weeks after injections. Anterior chamber fluorophotometry was studied in seven eyes (four patients) before and after injections. Ciliary body anatomy was evaluated in two patients.


RESULTS
After the first intravitreal injection, mean intraocular pressure was 2.2 mm Hg lower than that at baseline at 2 to 3 weeks (P < .001) and 1.3 mm Hg lower than at baseline at 5 to 6 weeks (P = .0025). After the second injection, mean pressure was 2.6 mm Hg lower at 2 to 3 weeks (P = .0013) and 1.5 mm Hg lower at 5 to 6 weeks (P = .043). After subsequent injections, however, the decrease was less than 1 mm Hg, suggesting that a plateau had been reached. Pressure in eyes with anterior uveitis after the first injection was lower than that in eyes without anterior uveitis (P < .0001). The mean rate of aqueous flow decreased from 2.8 to 1.9 microliters per minute 2 to 4 weeks after injection (P < .015). Ultrasound biomicroscopy disclosed that severe hypotony after cidofovir injections is associated with ciliary body atrophy.


CONCLUSIONS
Intraocular pressure decreases after the initial 20-microgram cidofovir intravitreal injection. However, eyes stabilize (pressure plateaus) after three injections. Effects on the ciliary body are the main cause of the decrease after cidofovir injections.
Banker
A S
AS
Department of Ophthalmology, Shiley Eye Center, University of California, San Diego, La Jolla 92093-0946, USA.
Arevalo
J F
JF
Munguia
D
D
Rahhal
F M
FM
Ishimoto
B
B
Berry
C
C
De Clercq
E
E
Ochabski
R
R
Taskintuna
I
I
Freeman
W R
WR
D000163:Acquired Immunodeficiency Syndrome / Q000503:physiopathology*; D000328:Adult; D000867:Anterior Chamber / Q000473:pathology; D000998:Antiviral Agents / Q000627:therapeutic use*; D001082:Aqueous Humor / Q000187:drug effects* / Q000502:physiology; D000077404:Cidofovir; D002924:Ciliary Body / Q000000981:diagnostic imaging / Q000187:drug effects; D003586:Cytomegalovirus Infections / Q000188:drug therapy* / Q000503:physiopathology; D003596:Cytosine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005260:Female; D015590:Fluorophotometry; D006801:Humans; D007267:Injections; D007429:Intraocular Pressure / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates; D009943:Organophosphorus Compounds / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D012173:Retinitis / Q000821:virology*; D014463:Ultrasonography; D014822:Vitreous Body
D000998:Antiviral Agents; D063065:Organophosphonates; D009943:Organophosphorus Compounds; D003596:Cytosine; D000077404:Cidofovir