Ostroumova O D, Chikh E V, Rebrova E V, Ryazanova A Y, Arzhimatova G Sh, Moshetova L K
I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
Russian Medical Academy of Continuing Professional Education, Moscow, Russia.
Vestn Oftalmol. 2020;136(4):156-164. doi: 10.17116/oftalma2020136041156.
Drug-induced optic neuropathy is a group of disorders in which medications cause degeneration of the optic nerve. The true prevalence of drug-induced neuropathy has not been studied, although the percentage of patients who develop optic nerve damage is known for individual medications. The common pathophysiological mechanisms are believed to be mitochondrial damage and imbalance of intracellular and extracellular free radical homeostasis. Typical symptoms of drug-induced neuropathy are reduced visual acuity in the central area, which is often bilateral, visual field disturbances, dyschromatopsia, and edema of the optic nerve head. Early detection of drug-induced optic neuropathy can potentially prevent or minimize serious complications. For patients who develop drug-induced optic neuropathy, treatment is based on timely diagnosis and cancellation of the provoking drug. In most patients, vision usually recovers a few weeks or months after discontinuation of previous therapy, but there have been cases of irreversible vision loss. In addition to withdrawal of the drug that caused optic nerve lesion, treatment of drug-induced neuropathy may include use of drugs and treatment methods prescribed by neurologists for peripheral neuropathy, however, such treatment is seldom based on evidence.
药物性视神经病变是一组因药物导致视神经退变的疾病。尽管已知个别药物导致视神经损伤的患者比例,但药物性神经病变的真实患病率尚未得到研究。常见的病理生理机制被认为是线粒体损伤以及细胞内和细胞外自由基稳态失衡。药物性神经病变的典型症状是中央区域视力下降,通常为双侧性,伴有视野障碍、色觉异常和视神经乳头水肿。早期发现药物性视神经病变有可能预防或减少严重并发症。对于发生药物性视神经病变的患者,治疗基于及时诊断并停用诱发药物。在大多数患者中,视力通常在停用先前治疗药物后的几周或几个月内恢复,但也有视力丧失无法恢复的病例。除了停用导致视神经病变的药物外,药物性神经病变的治疗可能包括使用神经科医生针对周围神经病变所开的药物和治疗方法,然而,这种治疗很少有循证依据。