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Treatment of Cytomegalovirus Retinitis with Intravitreous Cidofovir in Patients with AIDS: A Preliminary Report
- Firas M. Rahhal, MD;
- J. Fernando Arevalo, MD;
- Eugenio Chavez de la Paz, MD;
- David Munguia;
- Stanley P. Azen, PhD; and
- William R. Freeman, MD
- From the University of California School of Medicine, San Diego, San Diego, California, and the University of Southern California School of Medicine, Los Angeles, California. Grant Support: By National Institutes of Health grant E707366; a grant from Research to Prevent Blindness, Inc., New York, New York; and a core grant from the National Eye Institute. Requests for Reprints: William R. Freeman, MD, University of California, San Diego, Shiley Eye Center, Gilman Drive, La Jolla, CA 92093-0946. Current Author Addresses: Dr. Rahhal: Department of Ophthalmology, The New York Hospital-Cornell Medical Center, 525 East 68th Street, New York, NY 10021.
Abstract
Background: Cytomegalovirus retinitis remains a major cause of illness in patients with the acquired immunodeficiency syndrome (AIDS), and existing therapies for this condition are relatively ineffective and toxic.
Objective: To evaluate the efficacy of intravitreous cidofovir injections alone for initial and maintenance therapy for cytomegalovirus retinitis.
Design: Prospective, nonrandomized, consecutive case series.
Setting: University ophthalmology referral clinic.
Patients: 22 patients with AIDS and cytomegalovirus retinitis. In 15 of 32 affected eyes, intravitreous cidofovir was administered as the initial treatment for cytomegalovirus retinitis (group A); 17 eyes had previously been treated with intravenous therapy (group B).
Intervention: All eyes were intravitreously injected with 20 µg of cidofovir at 5- to 6-week intervals. No patient in either group received systemic anticytomegalovirus therapy at any time during the study period.
Measurements: Healing of retinitis was defined as resolution of retinal opacification and cessation of border progression. Progression, the primary end point, was defined as 750µmof border progression or development of a new lesion.
Results: The mean duration of follow-up was 15.3 weeks (range, 5 to 44 weeks). Of the eyes with active retinitis, 100% (95% CI, 87% to 100%) healed in response to the initial injection. In two eyes (6%; CI, 0% to 15%), two episodes of retinitis progression occurred (one in each eye). Both of these eyes were in a patient with clinically resistant retinitis. In 3% of eyes (CI, 0% to 9%), the retina became detached. Mild iritis developed after 14% of the injections that had been preceded by prophylaxis with oral probenecid. Irreversible, visually significant hypotonia developed in one eye.
Conclusion: Treatment and subsequent maintenance of cytomegalovirus retinitis with 20 µg of intravitreously injected cidofovir, given at 5- to 6-week intervals, is safe and highly effective.
- Copyright ©2004 by the American College of Physicians
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