Intraocular pressure and aqueous humor dynamics in patients with AIDS treated with intravitreal cidofovir (HPMPC) for cytomegalovirus retinitis.

Abstract

PURPOSE:

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.

• Authors: A S Banker, J F Arevalo, D Munguia, F M Rahhal, B Ishimoto, C Berry, E De Clercq, R Ochabski, I Taskintuna, W R Freeman
• Journal: American journal of ophthalmology (Am J Ophthalmol) Vol. 124 Issue 2 Pg. 168-80 (Aug 1997) ISSN: 0002-9394 [Print] United States
• PMID: 9262540 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Antiviral Agents
• Organophosphonates
• Organophosphorus Compounds
• Cytosine
• Cidofovir

Topics

• Acquired Immunodeficiency Syndrome (physiopathology)
• Adult
• Anterior Chamber (pathology)
• Antiviral Agents (therapeutic use)
• Aqueous Humor (drug effects, physiology)
• Cidofovir
• Ciliary Body (diagnostic imaging, drug effects)
• Cytomegalovirus Infections (drug therapy, physiopathology)
• Cytosine (adverse effects, analogs & derivatives, therapeutic use)
• Drug Administration Schedule
• Female
• Fluorophotometry
• Humans
• Injections
• Intraocular Pressure (drug effects)
• Male
• Middle Aged
• Organophosphonates
• Organophosphorus Compounds (adverse effects, therapeutic use)
• Prospective Studies
• Retinitis (virology)
• Ultrasonography
• Vitreous Body