Hsu S Tammy, Ponugoti Arathi, Deaner Jordan D, Vajzovic Lejla
Duke University School of Medicine, Durham, NC USA.
Department of Ophthalmology, Duke University Eye Center, 2351 Erwin Road, Durham, NC 27710 USA.
Curr Ophthalmol Rep. 2021;9(4):168-177. doi: 10.1007/s40135-021-00277-x. Epub 2021 Dec 21.
This review aims to provide an update on the clinical presentations and diagnostic findings of drug-induced retinal toxicities.
Several newly FDA-approved medications have been associated with acute retinal toxicities, including brolucizumab, MEK inhibitors, ulixertinib, and FGFR inhibitors. Additionally, as previously believed-to-be well-tolerated medications, such as pentosan sulfate sodium, anti-retroviral therapies, and certain intraoperative ocular medications, are used more frequently or for longer periods of time, associated toxic retinopathies and inflammatory reactions have been reported. Finally, advances in ocular imaging have revealed novel findings in hydroxychloroquine and tamoxifen maculopathies.
Discovery of new medications, increased frequency of use, and longer-term use have led to increased reports of retinal toxicities. Advances in retinal imaging have allowed for earlier detection of subclinical changes associated with these medications, which may help prevent progression of disease. However, more research is needed to determine the point at which vision loss becomes irreversible. Risks and benefits must be assessed prior to discontinuation of the offending, but potentially lifesaving, therapy.
本综述旨在提供药物性视网膜毒性的临床表现和诊断结果的最新信息。
几种新获得美国食品药品监督管理局(FDA)批准的药物与急性视网膜毒性有关,包括布罗珠单抗、丝裂原活化蛋白激酶(MEK)抑制剂、乌利西替尼和成纤维细胞生长因子受体(FGFR)抑制剂。此外,随着以前被认为耐受性良好的药物,如戊聚糖硫酸酯钠、抗逆转录病毒疗法和某些术中眼部用药的使用频率更高或时间更长,相关的毒性视网膜病变和炎症反应也有报道。最后,眼部成像技术的进展揭示了羟氯喹和他莫昔芬黄斑病变的新发现。
新药物的发现、使用频率的增加和长期使用导致视网膜毒性的报告增多。视网膜成像技术的进展使得能够更早地检测到与这些药物相关的亚临床变化,这可能有助于预防疾病进展。然而,需要更多的研究来确定视力丧失变得不可逆转的临界点。在停用有问题但可能挽救生命的治疗之前,必须评估风险和益处。