Whitcup S M, Dastgheib K, Nussenblatt R B, Walton R C, Pizzo P A, Chan C C
National Eye Institute, National Institutes of Health, Bethesda, Md.
Arch Ophthalmol. 1994 Dec;112(12):1594-8. doi: 10.1001/archopht.1994.01090240100033.
Didanosine, a purine analogue with antiretroviral activity, is used in the treatment of human immunodeficiency virus disease. Associated toxic effects of didanosine include pancreatitis, peripheral neuropathy, and retinopathy. The retinal lesions associated with didanosine therapy were studied in a 6-year-old girl with acquired immunodeficiency syndrome. Gross examination disclosed multiple well-circumscribed depigmented lesions in the midperipheral retina. Microscopic examination of these lesions showed multiple areas of retinal pigment epithelial (RPE) loss, some surrounded by areas of hypertrophy or hypopigmentation of the RPE. Partial loss of the choriocapillaris and neurosensory retina were also noted in areas of diseased RPE. Transmission electron microscopy showed numerous membranous lamellar inclusions and cytoplasmic bodies in the RPE cells. These data show that didanosine primarily affects the RPE and that the choriocapillaris and overlying neurosensory retina are also dystrophic in areas of RPE loss.
去羟肌苷是一种具有抗逆转录病毒活性的嘌呤类似物，用于治疗人类免疫缺陷病毒疾病。去羟肌苷的相关毒性作用包括胰腺炎、周围神经病变和视网膜病变。在一名患有获得性免疫缺陷综合征的6岁女孩中，对与去羟肌苷治疗相关的视网膜病变进行了研究。大体检查发现中周边视网膜有多个边界清晰的色素脱失病变。对这些病变进行显微镜检查显示，视网膜色素上皮（RPE）有多个区域缺失，有些区域被RPE肥大或色素减退区域包围。在病变的RPE区域还发现脉络膜毛细血管和神经感觉视网膜部分缺失。透射电子显微镜显示RPE细胞中有大量膜性板层包涵体和细胞质体。这些数据表明，去羟肌苷主要影响RPE，并且在RPE缺失区域，脉络膜毛细血管和上方的神经感觉视网膜也发生营养不良。
