Hypotony and visual loss with intravenous cidofovir treatment of cytomegalovirus retinitis.

Abstract

Cidofovir, a nucleotide analog, has recently been approved as intravenous treatment for cytomegalovirus (CMV) retinitis. A long halflife allows infrequent dosing, obviating the need for an indwelling catheter. The drug is most toxic in the kidneys. 1 Newly diagnosed and relapsed CMV retinitis has been treated with intravitreal cidofovir therapy. 2,3 In a dose escalation study, hypotony and vitritis occurred at high doses of intravitreal drug. 3 The intravitreal concentration of cidofovir after intravenous administration is unknown. This report describes the development of iritis, hypotony, and reversible visual loss in a patient receiving intravenous cidofovir therapy. See also pages 733 and 785 Report of a Case. Peripheral CMV retinitis was diagnosed in the left eye of a 41-year-old man with the acquired immunodeficiency syndrome and a CD4+ count of 0.01 ×10 9 /L (10 cells/μL) in May 1994. His visual acuity was 20/30 OS, and his intraocular pressure (IOP)