Офтальмологические побочные эффекты нейролептической терапии: семиотика, патогенез, лечение

Нейролептики — препараты, широко применяемые в психиатрической практике для лечения шизофрении, биполярного расстройства, а также вне инструкции для терапии других заболеваний, имеют немало побочных эффектов, в том числе офтальмологических. Некоторые из них, такие как стойкий мидриаз, паралич аккомодации, дистония глазодвигательных мышц, приступы зрительной гиперчувствительности, являются обратимыми, поскольку проходят после снижения дозы или отмены препарата. Однако другие побочные эффекты: катаракта, отек роговицы, приступ закрытоугольной глаукомы, поражения сетчатки — представляют опасность для зрения и могут привести к стойкому его снижению, вплоть до слепоты. В обзоре приведены данные о частоте выявления офтальмологических побочных эффектов (как типичных, так и атипичных) различных антипсихотических препаратов, их клинических проявлениях, патогенезе и лечении. Пациентам, принимающим нейролептики, показаны регулярные осмотры у офтальмолога — в начальном периоде терапии, далее каждые полгода. Врачам-психиатрам важно знать о побочных эффектах данных препаратов, а офтальмологам — их семиотику, патогенез и методы коррекции, поскольку своевременная диагностика и лечение патологических изменений, а также модификация антипсихотической терапии в подавляющем большинстве случаев предотвращают развитие тяжелых и необратимых нарушений зрения.

1. Park E.J., Amatya S., Kim M.S., et al. Long-acting injectable formulations of antipsychotic drugs for the treatment of schizophrenia. Arch. Pharm. Res. 2013; 36 (6): 651–9. doi: 10.1007/s12272-013-0105-7

2. Tsygankov B.D., Agasarian É.G. An analysis of efficacy and safety of modern and classical antipsychotic drugs. Zh. Nevrol. Psihiatr. Im. S.S. Korsakova. 2006; 106 (9): 87–93.

3. Maher A.R., Maglione M., Bagley S., et al. Efficacy and comparative effectiveness of atypical antipsychotic medications for off-label uses in adults: a systematic review and meta-analysis. JAMA. 2011; 306 (12): 1359–69. doi: 10.1001/jama.2011.1360

4. Howard P., Twycross R., Shuster J., Mihalyo M., Wilcock A. Antipsychotics.

5. J. Pain Symptom Manage. 2011; 41 (5): 956–65. doi: 10.1016/j.jpainsymman.2011.03.002

6. Kaar S. J., Natesan S., McCutcheon R., Howes O.D. Antipsychotics: Mechanisms underlying clinical response and side-effects and novel treatment approaches based on pathophysiology. Neuropharmacology. 2020; 172: 107704. doi: 10.1016/j.neuropharm.2019.107704

7. Richa S., Yazbek J.C. Ocular adverse effects of common psychotropic agents: a review. CNS Drugs. 2010; 24 (6): 501–26. doi: 10.2165/11533180-000000000-00000 7. Huff L. S., Prado R., Pederson J.F., Dunnick C.A., Lucas L.M. Chlorpromazineinduced skin pigmentation with corneal and lens opacities. Cutis. 2014; 93 (5): 247–50.

8. Molina-Ruiz A.M., Pulpillo ., Molina-Ruiz R.M., Sagrario T., Requena L. Chlorpromazine-induced severe skin pigmentation and corneal opacities in a patient with schizophrenia. Int. J. Dermatol. 2016; 55 (8): 909–1012. doi: 10.1111/ijd.13085

9. Kim S., Thomasy S.M., Ramsey D., et al. Whorl pattern keratopathies in veterinary and human patients. Vet. Ophthalmol. 2018; 21 (6): 661–7. doi: 10.1111/vop.12552

10. Raizman M.B., Hamrah P., Holland E.J., et al. Drug-induced corneal epithelial changes. Surv. Ophthalmol. 2017; 62 (3): 286–301. doi: 10.1016/j.survophthal.2016.11.008

11. Hamaguchi R., Haginaka J., Tanimoto T., Kuroda Y. Maintenance of luminal pH and protease activity in lysosomes/late endosomes by vacuolar ATPase in chlorpromazine-treated RAW264 cells accumulating phospholipids. Cell. Biol. Toxicol. 2014; 30 (1): 67–77. doi: 10.1007/s10565-014-9269-2

12. Gowda G.S., Hegde A., Shanbhag V., Narayanaswamy J.C., Jaisoorya T.S. Kerato-lenticular ocular deposits and visual impairment with prolonged chlorpromazine use: A case series. Asian J. Psychiatr. 2017; 25: 188-90. doi: 10.1016/j.ajp.2016.11.002

13. Koh V., Khor W.B., Lim L. Chlorpromazine-induced corneal toxicity. Arch. Ophthalmol. 2012; 130 (11): 1409. doi: 10.1001/archophthalmol.2012.475

14. Gokulgandhi M.R., Vadlapudi A.D., Mitra A.K. Ocular toxicity from systemically administered xenobiotics. Expert. Opin. Drug Metab. Toxicol. 2012; 8 (10): 1277–91. doi: 10.1517/17425255.2012.708337

15. Sie N.M., Yam G.H., Soh Y.Q., et al. Regenerative capacity of the corneal transition zone for endothelial cell therapy. Stem Cell Res. Ther. 2020; 11 (1): 523. doi:10.1186/s13287-020-02046-2

16. Farid M., Rhee M.K., Akpek E.K., et al. Corneal edema and opacification preferred practice pattern®. Ophthalmology. 2019; 126 (1): 216–85. doi: 10.1016/j.ophtha.2018.10.022

17. Siafis S., Tzachanis D., Samara M., Papazisis G. Antipsychotic drugs: from receptor-binding profiles to metabolic side effects. Curr. Neuropharmacol. 2018; 16 (8): 1210–23. doi: 10.2174/1570159X15666170630163616

18. Razeghinejad M.R., Pro M.J., Katz L.J. Non-steroidal drug-induced glaucoma. Eye (Lond). 2011; 25 (8): 971–80. doi: 10.1038/eye.2011.128

19. Oshika T. Ocular adverse effects of neuropsychiatric agents. Incidence and management. Drug Saf. 1995; 12 (4): 256–63. doi: 10.2165/00002018-199512040-00005

20. Ah-Kee E.Y., Egong E., Shafi A., Lim L.T., Yim J.L. A review of drug-induced acute angle closure glaucoma for non-ophthalmologists. Qatar Med. J. 2015; 6: 1–8. doi: 10.5339/qmj.2015.6

21. Yang M.C., Lin K.Y. Drug-induced acute angle-closure glaucoma: a review. J. Curr. Glaucoma Pract. 2019; 13 (3): 104–9. doi: 10.5005/jpjournals-10078-1261

22. Flores-S nchez B.C., Tatham A.J. Acute angle closure glaucoma. Br. J. Hosp. Med. (Lond). 2019; 80 (12): C174–9. doi: 10.12968/hmed.2019.80.12.C174

23. Chan P.P., Pang J.C., Tham C.C. Acute primary angle closure-treatment strategies, evidences and economical considerations. Eye (Lond). 2019; 33 (1): 110–9. doi: 10.1038/s41433-018-0278-x

24. Husain R., Gazzard G., Aung T., et al. Initial management of acute primary angle closure: a randomized trial comparing phacoemulsification with laser peripheral iridotomy. Ophthalmology. 2012; 119 (11): 2274–81. doi: 10.1016/j.ophtha.2012.06.015

25. Alam M.S., Praveen Kumar K.V. Clozapine-induced cataract in a young female. J. Pharmacol. Pharmacother. 2016; 7 (4): 184–6. doi: 10.4103/0976-500X.195904

26. Prokofyeva E., Wegener A., Zrenner E. Cataract prevalence and prevention in Europe: a literature review. Acta Ophthalmol. 2013; 91 (5): 395–405. doi: 10.1111/j.1755-3768.2012.02444.x

27. Ooi I.L.E., Umi Kalthum M.N., Suzaily W., Aida Zairani M.Z., Yong T.K. Ocular manifestation of chlorpromazine toxicity- a case report. J. Ophthalmic Pathol. 2014; 3 (2): 1–2. doi: 03. 10.4172/2324-8599.1000133

28. Tsygankov B.D., Agasaryan E.G., Zykova A.S. Antipsychotic drugs and their influence on the carbohydrate metabolism in patients with schizophreniaspectrum disorders. Zh. Nevrol. Psihiatr. im. S.S. Korsakova. 2014; 5: 86–91.

29. Lim C.Z., Sonny Teo K.S., Tai E. Olanzapine-induced cataract in a teenage girl. Cureus. 2018; 10 (4): e2553. doi: 10.7759/cureus.2553

30. Chou P.H., Chu C S., Lin C.H., et al. Use of atypical antipsychotics and risks of cataract development in patients with schizophrenia: A population-based, nested case-control study. Schizophr. Res. 2016; 174 (1–3): 137–43. doi: 10.1016/j.schres.2016.03.027

31. Olson R.J., Braga-Mele R., Chen S.H., et al. Cataract in the adult eye preferred practice pattern®. Ophthalmology. 2017; 124 (2): 1–119. doi: 10.1016/j.ophtha.2016.09.027

32. Chu C.S., Chou P.H., Chen Y.H., et al. Association between antipsychotic drug use and cataracts in patients with bipolar disorder: A population-based, nested case-control study. J. Affect. Disord. 2017; 209: 86–92. doi: 10.1016/j.jad.2016.11.019

33. Corradetti G., Violanti S., Au A., Sarraf D. Wide field retinal imaging and the detection of drug associated retinal toxicity. Int. J. Retina Vitreous. 2019; 5 (Suppl 1): 26. doi: 10.1186/s40942-019-0172-0

34. Scholz R.T.S., Sunness J.S. Dark adaptation abnormalities and recovery in acute thioridazine toxicity. Retin. Cases Brief Rep. 2014; 8 (1): 45–9. doi: 10.1097/ICB.0000000000000000

35. Faure C., Audo I., Zeitz C., Letessier J.B., Robert M.P. Aripiprazole-induced chorioretinopathy: multimodal imaging and electrophysiological features. Doc. Ophthalmol. 2015; 131 (1): 35–41. doi: 10.1007/s10633-015-9494-x

36. Sönmez I., Aykan U. Psychotropic Drugs and Ocular Side Effects. Turk. Oftalmoloiji Dergisi. 2013; 43: 270–7. doi: 10.4274/tjo.43.67944

37. Power W.J., Travers S.P., Mooney D.J. Welding arc maculopathy and fluphenazine. Br. J. Ophthalmol. 1991; 75 (7): 433–5. doi: 10.1136/bjo.75.7.433

38. Lee M.S., Fern A.I. Fluphenazine and its toxic maculopathy. Ophthalmic Res. 2004; 36 (4): 237–9. doi: 10.1159/000078784

39. Manousaridis K., Gupta R. Risperidone-related bilateral cystoid macular oedema. Graefes Arch. Clin. Exp. Ophthalmol. 2013; 251 (3): 1037–8. doi: 10.1007/s00417-012-2071-z

40. Kozlova A., McCanna C.D., Gelman R. Risperidone-related bilateral cystoid macular edema: a case report. J. Med. Case Rep. 2019; 13 (1): 59. doi: 10.1186/s13256-019-1978-y

41. Jain M. Quetiapine associated central serous chorioretinopathy: implicit role of serotonin and dopamine pathways. Indian J. Ophthalmol. 2019; 67 (2): 292–4. doi: 10.4103/ijo.IJO_929_18

42. Barow E., Schneider S.A., Bhatia K.P., Ganos C. Oculogyric crises: etiology, pathophysiology and therapeutic approaches. Parkinsonism Relat. Disord. 2017; 36: 3–9. doi: 10.1016/j.parkreldis.2016.11.012

43. Caffrey D., Sowden G.L. A missed case of lurasidone induced laryngospasm: A case study and overview of extrapyramidal symptom identification and treatment. Int. J. Psychiatry Med. 2021: 56 (2): 73–82. doi: 10.1177/0091217420943786

44. Mahal P., Suthar N., Nebhinani N. Spotlight on oculogyric crisis: A review. Indian J. Psychol. Med. 2021; 43 (1): 5–9. doi: 10.1177/0253717620942096

45. Tahir H., Daruwalla V. Phencyclidine induced oculogyric crisis responding well to conventional treatment. Case Rep. Emerg. Med. 2015; 8: 1–3. doi: 10.1155/2015/506301

46. Uchida H., Suzuki T., Yamazawa R., et al. Reducing the dose of antipsychotic agents ameliorates visual hypersensitivity attack: an ideal treatment option in terms of the adverse effect. J. Clin. Psychopharmacol. 2006; 26 (1): 50–5. doi: 10.1097/01.jcp.0000195384.04008.25

47. Ceylan E., Ozer M.D., Yilmaz Y.C., et al. The ocular surface side effects of an anti-psychotic drug, clozapine. Cutan. Ocul. Toxicol. 2016; 35 (1): 62–6. doi: 10.3109/15569527.2015.1018387

48. de Oliveira R.C., Wilson S.E. Practical guidance for the use of cyclosporine ophthalmic solutions in the management of dry eye disease. Clin. Ophthalmol. 2019; 13: 1115–22. doi: 10.2147/OPTH.S184412

49. Cumurcu T., Cumurcu B.E., Yesil B., Gunduz A. Aripiprazole-induced transient myopia. North Clin. Istanb. 2019; 7 (5): 516–8. doi: 10.14744/nci.2019.65625

50. Praveen Kumar K.V., Chiranjeevi P., Alam M.S. Aripiprazole-induced transient myopia: A rare entity. Indian J. Ophthalmol. 2018; 66 (1): 130–1. doi: 10.4103/ijo.IJO_907_16

51. Karadağ H., Acar M., Özdel K. Aripiprazole induced acute transient bilateral myopia: a case report. Balkan Med. J. 2015; 32 (2): 230–2. doi: 10.5152/balkanmedj.2015.15292

52. Nair A.G., Nair A.G., George R.J., Biswas J., Gandhi R.A. Aripiprazole induced transient myopia: a case report and review of literature. Cutan. Ocul. Toxicol. 2012; 31 (1): 74–6. doi: 10.3109/15569527.2011.603106

53. Selvi Y., Atli A., Aydin A., Yener H.I. Aripiprazole-related acute transient myopia and diplopia: a case report. J. Clin. Psychopharmacol. 2011; 31 (2): 249–50. doi: 10.1097/JCP.0b013e3182103493