Добавил:
kiopkiopkiop18@yandex.ru t.me/Prokururor I Вовсе не секретарь, но почту проверяю Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз: Предмет: Файл:
Ординатура / Офтальмология / Английские материалы / Clinical Ocular Toxicology Drug-Induced Ocular Side Effects_Fraunfelder, Chambers _2008.pdf
Скачиваний:
0
Добавлен:
28.03.2026
Размер:
26.67 Mб
Скачать

Part

7 Drug-induced ocular side effects

SECTION 1

Anti-Infectives

Class: Aids-Related Agents

Generic name: Didanosine.

Proprietary name: Videx.

may encroach on the posterior pole if the drug is continued at high dosage. To date, central visual acuity has been preserved. Didanosine’s toxic effects on the retina appear related both to peak dosage and accumulated dosage. Toxicity appears to be worse in patients with advanced stages of HIV disease. Patients taking this drug should be monitored for the development and progression of retinal lesions. Cobo et al (1996) contend that retinal toxicity to this drug is under-recognized.

Recommendations

Primary use

1. Patients on this drug should be questioned as to visual

symptoms, including specific questions regarding night

A purine analogue with antiretrovirus activity used in HIV

vision, scotoma and constriction of visual fields.

infections­

.

2. If any of the above problems occur, visual fields and/or elec-

Ocular side effects

trophysiologic studies (i.e. EOGs) should be considered.

3. Since many patients are unaware of visual changes, consider

Systemic administration

a visual field test in patients on didanosine for over 2 years.

4. This drug may need to be stopped in some patients based

Certain

 

on retinal changes and the prognosis of some improvement

1. Retina – choroid

if didanosine is discontinued.

a. RPE mottling

 

b. RPE atrophy

References and Further Reading

c. RPE hypertrophy

Cobo J, et al. Retinal toxicity associated with didanosine in HIV-infected

d. Abnormality of neurosensory retina

e. Loss of choriocapillaris

adults. AIDS 10: 1297-1300, 1996.

Nguyen BY, et al. A pilot study of sequential therapy with zidovudine plus

2. EOGs – reduced Arden ratio

acyclovir, dideoxyinosine, and dideoxycytidine in patients with severe hu-

3. Visual

field defects

man immunodeficiency virus infection. J Infect Dis 168: 810-817, 1993.

a. Scotoma

Whitcup SM, et al. Retinal toxicity in human immunodefciency virus

b. Constriction

infected children treated with 2’,3’-dideoxyinosine. Am J Ophthalmol

4. Night blindness

113: 1-7, 1992.

Whitcup SM, et al. A clinicopathologic report of the retinal lesions associ-

5. Optic neuritis

ated with didanosine. Arch Ophthalmol 112: 1594-1598, 1994.

Clinical significance

Didanosine is somewhat unique in that significant neurosensory retinal problems may occur without visual funduscopic changes. Whitcup et al (1992, 1994) described retinal lesions that first appear as patches of RPE mottling and atrophy in the midperiphery of the fundi in children taking didanosine. In time, these lesions became more circumscribed and developed a border of RPE hypertrophy. Cobo et al (1996) described similar changes in adults. Electrophysiological and ophthalmalogical findings suggest diffuse dysfunction of the RPE. Histological findings confirm multiple areas of RPE loss. Electron microscopic findings show normal mitochondria, but with membranous lamellar inclusions and cytoplasmic bodies in the RPE, which resemble the inclusion in lysosomal storage diseases. If didanosine therapy continues progression will occur, although there is some improvement once the drug is stopped. Night blindness and EOG changes appear to be reversible once the drug is discontinued. Although the midperiphery is the area first involved, lesions

Generic name: Zidovudine.

Proprietary name: Retrovir.

Primary use

Zidovudine is used in the management of AIDS and AIDSrelated complex.

Ocular side effects

Systemic administration (oral or intravenous)

Certain

1. Hypertrichosis

2. Eyelids

a. Urticaria

45

Соседние файлы в папке Английские материалы