Chavez-de la Paz E, Arevalo J F, Kirsch L S, Munguia D, Rahhal F M, De Clercq E, Freeman W R
Department of Ophthalmology, Shiley Eye Center, University of California San Diego, La Jolla 92093-0946, USA.
Ophthalmology. 1997 Mar;104(3):539-44. doi: 10.1016/s0161-6420(97)30278-4.
The authors characterize and analyze the incidence of a previously reported mild anterior nongranulomatous uveitis associated with intravitreal injections of (S)-1-(3-hydroxy-2-phosphonylmethoxypropyl)cytosine (HPMPC), also termed cidofovir (Vistide, Gilead Sciences, Foster City, CA). This is an acyclic nucleoside phosphonate analogue with a potent anticytomegalovirus effect. The authors also analyzed the effects of probenecid therapy, as well as prophylaxis with probenecid plus topical corticosteroids and cycloplegics on the course and outcome of the uveitis.
Prospective case series from a tertiary referral center, which included 46 consecutive patients with acquired immune deficiency syndrome (AIDS) and cytomegalovirus (CMV) retinitis. There was a total of 130 injections in 69 eyes treated with 20 micrograms of intravitreal HPMPC. Forty-one patients (119 injections) received oral probenecid, 5 patients (11 injections) did not, and 21 patients (53 injections) received topical corticosteroids and cycloplegics as an adjuvant to probenecid in the prophylaxis of iritis.
Mild to moderate nongranulomatous iritis was seen in 26% of patients after their first injection (n = 12). Patients receiving probenecid prophylaxis after first injection had a significantly lower frequency of iritis versus patients who did not receive probenecid at the time of first injection (P = 0.0089). In contrast, treatment with topical corticosteroid and cycloplegics after injection did not statistically significantly affect the frequency of iritis in patients (P = 0.44). The development of iritis after a second injection of HPMPC was more likely if it had occurred after the initial injection (P = 0.015; Fisher's exact test). All cases of iritis were treated with topical corticosteroids and cycloplegics, and there was no permanent impairment of vision secondary to iritis after HPMPC injection in any eyes.
Anterior uveitis was seen in 26% of patients after first-time HPMPC injection. Concomitant use of probenecid appears to decrease the frequency of the iritis from 71% to 18% in patients with AIDS and CMV retinitis after the first intravitreal injection of HPMPC. Topical corticosteroid administration after injection (before iritis) was ineffective in preventing iritis treatment with topical corticosteroids and cycloplegics resulted in resolution of all iritis cases.
作者对先前报道的与玻璃体内注射（S）-1-（3-羟基-2-膦酰甲氧基丙基）胞嘧啶（HPMPC，也称为西多福韦，商品名Vistide，吉利德科学公司，加利福尼亚州福斯特城）相关的轻度前部非肉芽肿性葡萄膜炎的发病率进行了特征描述和分析。这是一种具有强效抗巨细胞病毒作用的无环核苷膦酸类似物。作者还分析了丙磺舒治疗的效果，以及丙磺舒联合局部使用皮质类固醇和睫状肌麻痹剂对葡萄膜炎病程和结局的影响。
来自一家三级转诊中心的前瞻性病例系列研究，纳入了46例连续的获得性免疫缺陷综合征（AIDS）合并巨细胞病毒（CMV）视网膜炎患者。总共对69只眼进行了130次玻璃体内注射20微克HPMPC的治疗。41例患者（119次注射）接受口服丙磺舒，5例患者（11次注射）未接受，21例患者（53次注射）接受局部皮质类固醇和睫状肌麻痹剂作为丙磺舒预防虹膜炎的辅助治疗。
首次注射后，26%的患者（n = 12）出现轻度至中度非肉芽肿性虹膜炎。首次注射后接受丙磺舒预防的患者虹膜炎发生率明显低于首次注射时未接受丙磺舒的患者（P = 0.0089）。相比之下，注射后使用局部皮质类固醇和睫状肌麻痹剂治疗对患者虹膜炎发生率无统计学显著影响（P = 0.44）。如果首次注射后发生虹膜炎，第二次注射HPMPC后更有可能再次发生虹膜炎（P = 0.015；Fisher精确检验）。所有虹膜炎病例均用局部皮质类固醇和睫状肌麻痹剂治疗，且在任何眼中，HPMPC注射后均未因虹膜炎导致永久性视力损害。
首次注射HPMPC后，26%的患者出现前部葡萄膜炎。在首次玻璃体内注射HPMPC后，对于患有AIDS和CMV视网膜炎的患者，同时使用丙磺舒似乎可将虹膜炎发生率从71%降至18%。注射后（在虹膜炎发生前）局部使用皮质类固醇预防虹膜炎无效，使用局部皮质类固醇和睫状肌麻痹剂治疗可使所有虹膜炎病例得到缓解。
