Ophthlamology Fellow, Greenlane Clinical Centre, Auckland.
Ophthlamologist, Greenlane Clinical Centre, Auckland.
N Z Med J. 2020 Dec 18;133(1527):83-94.
Drug-induced ocular inflammation is rare and may be overlooked as a cause of uveitis. The main objective was to describe the causes of drug-induced ocular inflammation. Secondary objectives included uveitis complications and drug rechallenge reactions.
A retrospective chart review at Auckland District Health Board's tertiary uveitis clinic (Auckland, New Zealand) was performed. Participants were identified using the uveitis database, which consists of 2,750 subjects. Fifty eyes of 35 subjects had drug-induced inflammation.
Drug-induced inflammation occurred in 1.3% of subjects with uveitis. Mean age was 66.8±15.6 years, and 25 subjects (71.4%) were female. Drugs responsible were bisphosphonates (24 subjects, 68.6%), brimonidine (one subject, 2.9%), etanercept (three subjects, 8.6%), immune checkpoint inhibitors (two subjects, 5.7%), BRAF inhibitors (three subjects, 8.6%), EGFR inhibitors (one subject, 2.9%) and allopurinol/perindopril (one subject, 2.9%). In subjects with bisphosphonate inflammation, anterior uveitis occurred in 22 (91.7%) and scleritis in two (8.3%). A positive rechallenge reaction occurred in two subjects with zoledronate and one with alendronate. Uveitis occurred in six subjects (17.1%) treated with cancer drugs including immune checkpoint inhibitors, BRAF inhibitors and EGFR protein kinase inhibitors. Subjects with cancer-drug-induced uveitis were managed with corticosteroids and five subjects were able to continue therapy; in one subject uveitis was uncontrollable and required drug cessation.
Ocular inflammation caused by bisphosphonates is usually mild and resolves on medication withdrawal. Uveitis seen in association with newer cancer medications can be more severe, but in most cases it can be managed without medication cessation.
药物引起的眼部炎症罕见，可能被忽视为葡萄膜炎的病因。主要目的是描述药物引起的眼部炎症的病因。次要目的包括葡萄膜炎的并发症和药物再激发反应。
对奥克兰地区卫生局三级葡萄膜炎诊所（新西兰奥克兰）的病历进行回顾性图表审查。使用葡萄膜炎数据库识别参与者，该数据库包含 2750 名患者。50 只眼 35 名患者出现药物性炎症。
葡萄膜炎患者中有 1.3%发生药物性炎症。平均年龄为 66.8±15.6 岁，25 名患者（71.4%）为女性。引起炎症的药物分别为双膦酸盐（24 名患者，68.6%）、溴莫尼定（1 名患者，2.9%）、依那西普（3 名患者，8.6%）、免疫检查点抑制剂（2 名患者，5.7%）、BRAF 抑制剂（3 名患者，8.6%）、EGFR 抑制剂（1 名患者，2.9%）和别嘌醇/培哚普利（1 名患者，2.9%）。双膦酸盐炎症患者中，22 名（91.7%）出现前葡萄膜炎，2 名（8.3%）出现巩膜炎。2 名唑来膦酸盐和 1 名阿仑膦酸盐患者出现阳性再激发反应。6 名（17.1%）接受癌症药物治疗的患者出现葡萄膜炎，包括免疫检查点抑制剂、BRAF 抑制剂和 EGFR 蛋白激酶抑制剂。接受癌症药物治疗的葡萄膜炎患者采用皮质类固醇治疗，其中 5 名患者能够继续治疗；1 名患者葡萄膜炎无法控制，需要停药。
双膦酸盐引起的眼部炎症通常较轻，停药后可缓解。与新型癌症药物相关的葡萄膜炎可能更严重，但在大多数情况下无需停药即可治疗。
