The University of New South Wales, Sydney, NSW, Australia.
Sydney Eye Hospital, Sydney, NSW, Australia.
CNS Drugs. 2021 Mar;35(3):283-289. doi: 10.1007/s40263-020-00790-w. Epub 2021 Feb 19.
This article provides a practical review of the diagnosis and management of angle closure induced by psychotropic agents, including tricyclic antidepressants, antipsychotics and anticonvulsants. Selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, monoamine oxidase inhibitors and antipsychotics may trigger angle closure by influencing pupil configuration through adrenergic, anticholinergic, serotonergic or dopaminergic mechanisms. Patients with narrow iridocorneal angles are at risk, and these are more common in people with hypermetropia (near-sightedness), older people and individuals with an Asian background. These patients may benefit from a laser peripheral iridotomy, either prophylactically or to relieve an acute angle-closure episode. An idiosyncratic reaction to medications such as topiramate may lead to angle closure through an alternate mechanism, leading to a uveal effusion. Ophthalmological review may be considered prior to commencing medications in high-risk patients.
本文对精神药物（包括三环类抗抑郁药、抗精神病药和抗惊厥药）诱发的闭角型青光眼的诊断和治疗进行了实用综述。选择性 5-羟色胺再摄取抑制剂、5-羟色胺-去甲肾上腺素再摄取抑制剂、单胺氧化酶抑制剂和抗精神病药可能通过影响瞳孔的肾上腺素能、抗胆碱能、5-羟色胺能或多巴胺能机制引起房角关闭。窄房角的患者有发病风险，这些患者在远视（近视）、老年人和亚洲背景的人群中更为常见。这些患者可能受益于激光周边虹膜切开术，无论是预防性的还是为了缓解急性闭角型青光眼发作。托吡酯等药物的特异质反应可能通过另一种机制导致房角关闭，导致葡萄膜渗出。在高风险患者开始用药前，可能需要进行眼科检查。
