Anterior uveitis and hypotony after intravenous cidofovir for the treatment of cytomegalovirus retinitis.

OBJECTIVE: This study aimed to describe the incidence and risk factors for the development of anterior uveitis in patients receiving intravenous cidofovir for the treatment of longstanding cytomegalovirus retinitis. DESIGN: The study design was a retrospective cohort. PARTICIPANTS: Eighteen patients (30 eyes) receiving parenteral cidofovir for the treatment of complicated cytomegalovirus retinitis participated. MAIN OUTCOME MEASURES: The clinical response to parenteral cidofovir; the occurrence of anterior uveitis, and the management and outcome of patients with this complication; and the effect of cidofovir on intraocular pressure measurements were measured. RESULTS: There was no progression or relapse of retinitis in patients receiving intravenous cidofovir. Eight (44%) of the 18 patients developed anterior uveitis, which occurred after a median of 4 doses of intravenous cidofovir. The median CD4+ cell count at the time of development of iritis was 101/mm3. Patients who developed uveitis had a mean increase in serum creatinine over baseline measurements (P = 0.05). The use of human immunodeficiency virus type-1 (HIV-1) protease inhibitors was not different between both groups of patients (P = 1.0). The development of anterior uveitis and visually significant hypotony necessitated withdrawal of cidofovir in only one patient. CONCLUSIONS: Anterior uveitis was a common complication after intravenous cidofovir therapy. Despite the frequency of this complication, continued treatment with intravenous cidofovir was possible in the majority of patients. Patients with anterior uveitis after intravenous cidofovir may be treated successfully with topical corticosteroid therapy and cycloplegic agents.

Use of fluconazole in the treatment of candidal endophthalmitis.

Candidal endophthalmitis is a sight-threatening ocular infection that most frequently occurs as a complication of candidemia. While amphotericin B is considered the gold standard for the treatment of most invasive fungal infections, the optimal management of candidal endophthalmitis has not been determined. Fluconazole, a triazole antifungal agent, has been shown to be effective in the management of a number of invasive fungal infections in both immunocompromised and immunocompetent hosts. We describe the clinical features and outcomes for six patients with candidal endophthalmitis who were treated with fluconazole at our institutions, and we review 21 additional cases reported in the English-language literature. In total, fluconazole has been used as the sole therapy for candidal endophthalmitis in 14 patients; 16 eyes were infected. Endophthalmitis was cured in 15 of 16 eyes (94%), including five infections that were complicated by vitreitis. Successful treatment required the administration of fluconazole (100-200 mg po) daily for approximately 2 months. In addition, fluconazole has been used in combination with pars plana vitrectomy for the successful treatment of four cases of candidal endophthalmitis that were complicated by moderate to severe vitreitis. Fluconazole appears to be a safe and effective alternative or addition to conventional treatments for the management of candidal endophthalmitis. Prospective evaluation is required to more clearly define the role of this antifungal agent in the management of ocular infections due to Candida species.