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[Bilateral uveitis with definitive hypotony caused by systemic cidofovir]
P Rapp1, F Pilon, F Chiambaretta
1Service d'Ophtalmologie, Hôpital G Montpied, CHU de Clermont-Ferrand.
Journal Francais D'Ophtalmologie
|September 18, 2003
Summary
This case study details a patient with AIDS and CMV retinitis who developed vision loss and hypotony after ganciclovir and cidofovir treatment. Researchers hypothesize iatrogenic ciliary body necrosis caused these permanent complications.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Toxicology
Background:
- Cytomegalovirus (CMV) retinitis is a serious complication in patients with Acquired Immunodeficiency Syndrome (AIDS).
- Antiviral therapies like ganciclovir and cidofovir are used to treat CMV retinitis, but can have ocular side effects.
Observation:
- A 52-year-old male with AIDS and CMV bilateral retinitis experienced a sharp decrease in visual acuity during antiviral treatment.
- The patient developed anterior uveitis, +11 hypermetropia, choroidal edema, bilateral cataract, and persistent hypotony despite treatment modifications.
Findings:
- Despite initial treatment with ganciclovir and subsequent cidofovir, the patient's visual acuity declined.
- Cidofovir was discontinued due to inefficacy and replaced with foscarnet, leading to uveitis resolution but persistent ciliary secretion and hypotony.
- The case presents with permanent hypotony and bilateral uveitis, with literature indicating chronic hypotony occurs in only 3% of cases.
Implications:
- This case suggests a potential link between antiviral therapy for CMV retinitis and iatrogenic ciliary body necrosis.
- The findings highlight the importance of monitoring for ocular complications, including hypotony and uveitis, during CMV retinitis treatment in AIDS patients.
- Further research into the mechanisms of antiviral-induced ciliary body damage may inform safer treatment strategies.