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Chemotherapeutische Nebenwirkungen im Augenbereich

Ophthalmic complications due to cytotoxic chemotherapy

  • Übersichtsarbeiten
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Zusammenfassung

Problemstellung

Die ständig wachsende Liste an Chemotherapeutika veranlasste uns eine aktuelle Übersichtsarbeit, welche die Nebenwirkungen im Augenbereich darstellt, zu verfassen. Da das Sehvermögen eine Lebensqualität ist, die im Rahmen von Voruntersuchungen und eventuellen regelmäßigen Kontrollen erhalten werden kann, ist es für den Onkologen als auch für den Ophthalmologen wichtig, dass beide über die Augennebenwirkungen der geläufigen Chemotherapeutika Bescheid wissen. Eine Früherkennung und rechtzeitige Behandlung der Nebenwirkungen im Augenbereich kann oftmals den Sehverlust oder bleibende Folgeschäden verhindern.

Methoden und/oder Patienten

Es wurde eine Übersichtsarbeit verfasst, die alle Augennebenwirkungen der heute verwendeten Chemotherapeutika zusammenfasst. Die Literatursuche wurde im MEDLINE durchgeführt und die Übersichtsarbeit beinhaltet alle beschriebenen Augennebenwirkungen von 1966 bis August 2003. Die Chemotherapeutika wurden nach ihren verschiedenen Wirkungsmechanismen in folgende Gruppen eingeteilt: Alkylantien, Antimetabolite, Mitose Inhibitoren, Antibiotika und hormonelle Antagonisten. Bei jeder Substanz wird kurz die Verwendung und der Wirkmechanismus beschrieben, bevor auf die Augennebenwirkungen eingegangen wird.

Ergebnisse

Geringgradige Nebenwirkungen im Augenbereich kommen häufig bei niedrig dosierten Chemotherapien vor. Diese sind aber meist reversibel und verschwinden auch schnell wieder nach Beendigung der Therapie. Hochdosierte Chemotherapien, starke Kombinationstherapien und intraarterielle Verabreichung mancher Substanzen kann hingegen irreversible Schäden zur Folge haben. Bei der rechtzeitigen Erkennung solcher Nebenwirkungen muss eine Dosisreduzierung oder sogar Therapieunterbrechung in Betracht gezogen werden, um den Sehverlust zu verhindern.

Schlussfolgerungen

Onkologen und Ophthalmologen sollten sich über die Augennebenwirkungen von Chemotherapien bewusst sein. Durch eine ophthalmologische Voruntersuchung, vor Beginn der Chemotherapie, können gefährdete Patienten ermittelt und zu Kontrolluntersuchungen wiederbestellt werden. Bei manchen Chemotherapieschemen sind laufende Kontrolluntersuchungen ohnehin zu empfehlen. Bei Auftreten von gravierenden Augennebenwirkungen soll auf jeden Fall an eine Dosisreduzierung, oder sogar an eine Therapieunterbrechung gedacht werden, da es bei der Tumorbekämpfung auch zum Sehverlust kommen kann.

Summary

Background

The constantly growing list of cytotoxic chemotherapeutics affords a new survey of ophthalmic complications, which are often underestimated. Vision is a quality of life, which needs to be taken care of, especially if loss of vision can be prevented. The broad spectrum of ophthalmic complications, induced by cytotoxic chemotherapy, includes reversible and irreversible, acute and chronic disorders.

Methods

A review of the literature reporting ophthalmic complications of currently used cytotoxic chemotherapeutics in oncology was conducted. Literature was searched in Medline from 1995 until August 2003. Further literature was then found in the references of the pre-selected literature.

Results

Ophthalmic complications of low-grade, induced by cytotoxic chemotherapy, are very common and reversible after cessation of anticancer therapy. Some major ocular toxicities may even afford a dose reduction or discontinuation of cytotoxic chemotherapy, in order to impede loss of vision.

Conclusion

Oncologists and ophthalmologists must be aware of potential ophthalmic complications during cytotoxic chemotherapy. Ocular toxicities can be treated or even prevented, if detected on time, which is why immediate consultation of an ophthalmologist seems to be necessary, as soon as symptoms are recognized. An ophthalmic baseline examination, prior to anticancer treatment, may also lead to a reduction of ocular side effects.

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  1. Department of Ophthalmology, Rudolf Foundation Clinic, The Ludwig Boltzmann Institute of Retinology and Biomicroscopic Lasersurgery, Juchgasse 25, 1030, Vienna, Austria

    K. E. Schmid & S. Binder

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  1. K. E. Schmid
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  2. S. Binder
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Schmid, K.E., Binder, S. Chemotherapeutische Nebenwirkungen im Augenbereich. Spektrum Augeheilkd 19, 210–220 (2005). https://doi.org/10.1007/BF03163400

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