SSRIs and intraocular pressure modifications - Evidence, therapeutic implications and possible mechanisms
SSRIs and intraocular pressure modifications - Evidence, therapeutic implications and possible mechanisms
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DOI：
10.2165/00023210-200418080-00001
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发表时间：
2004-01-01
期刊：
影响因子：
6
通讯作者：
Sebastiani, A
中科院分区：
文献类型：
--
作者：
Costagliola, C;Parmeggiani, F;Sebastiani, A
SSRIs 是最常用的抗抑郁药物，部分原因是与旧的抗抑郁药物相比，它们具有良好的安全性。然而，SSRIs 的广泛使用导致罕见不良反应的发生率增加。这篇综述基于已发表的实验研究、临床研究和病例报告的数据，描述了血清素在控制眼压 (IOP) 中的作用以及接受 SSRI 治疗的患者眼压改变的证据。 在一小部分抑郁症患者中，SSRI 戒断的原因是发生了不明确的视觉障碍。可以推测，在其中一些患者中，医源性眼部改变可能是由于眼压变化所致。在 SSRIs 治疗期间发生青光眼急性发作的病例报告数量有限。尽管没有明确指出因果关系，但 SSRI 与这种眼部不良事件之间的关系已被强烈暗示。然而，在一项评估单剂量氟西汀对眼压影响的小型临床研究中，该药物被证明可以增加该参数，尽管这种影响是无症状的。意外药物不良反应的临床症状常常被忽视，但那些以严重症状为特征的症状除外（例如眼压调整时的急性闭角型青光眼）。此外，一般人群中虹膜角膜角结构的分布表明，大多数患者（间歇性、亚急性或进行性闭角型青光眼）对眼压的不良影响很少或无症状。因此，与 SSRI 相关的眼压改变的发生率可能被低估。在更好地了解 SSRI 与眼压改变的关系之前，对于有青光眼危险因素的患者，尤其是老年人，在开始使用任何 SSRI 之前和治疗期间，应考虑进行眼科咨询。
SSRIs are the most commonly prescribed antidepressant drugs, in part because of their favourable safety profile compared with older antidepressants. However, the widespread use of SSRIs leads to an increased occurrence of rare adverse effects. This review, based on data from published experimental research, clinical studies and case reports, describes the role of serotonin in the control of intraocular pressure (IOP) and the evidence for IOP modifications in patients receiving SSRIs.In a small percentage of patients with depression, the cause of SSRI withdrawal has been the occurrence of ill-defined visual disturbances. It can be speculated that in some of these patients, the iatrogenic ocular alterations could have been due to changes in IOP. There have also been a limited number of case reports of acute attacks of glaucoma occurring during treatment with SSRIs. Although causality is not exactly specified, the relationship between SSRIs and this ocular adverse event is strongly implied. Nevertheless, in a small clinical study assessing the effect of a single dose of fluoxetine on IOP, the drug was shown to increase this parameter, although the effect was asymptomatic. The clinical signs of unexpected adverse drug effects are often disregarded, with the exception of those characterised by serious symptoms (such as acute angle-closure glaucoma in the case of IOP modifications). Also, the distribution of iridocorneal angle configurations in the general population implies that an adverse effect on IOP will be pauci- or asymptomatic in most patients (intermittent, sub-acute or progressive angle-closure glaucoma). As a result, it is likely that the incidence of SSRI-related IOP modifications is underestimated.Until the involvement of SSRIs in IOP modifications is better understood, ophthalmological consultations should be considered before starting and during treatment with any SSRI in patients with glaucomatous risk factors, especially those who are elderly.