Corneal nerve changes following treatment with neurotoxic anticancer drugs
Corneal nerve changes following treatment with neurotoxic anticancer drugs
复制标题
DOI：
10.1016/j.jtos.2021.06.007
复制
发表时间：
2021-06-21
期刊：
影响因子：
6.4
通讯作者：
Markoulli, Maria
中科院分区：
文献类型：
--
作者：
Chiang, Jeremy Chung Bo;Goldstein, David;Markoulli, Maria
随着包括全身化疗药物在内的抗癌药物的发展，癌症的存活率有所提高。然而，长期的副作用可能会影响接受治疗的患者。神经毒性抗癌药物是导致化疗所致周围神经病变(CIPN)的特异性药物，CIPN是一种严重恶化癌症患者和幸存者生活质量的衰弱疾病。眼表也容易出现神经毒性，但与糖尿病等其他系统病因相比，神经毒性化疗对眼表影响的研究更为有限。对于CIPN的诊断也没有标准化的方案，也缺乏可靠的、客观的方法来观察神经损伤的结构。由于角膜是人体神经分布最密集的区域，研究人员已开始关注与神经毒性化疗相关的角膜神经病变。活体角膜共聚焦显微镜能够快速和客观地对眼表面微观结构进行成像，例如角膜神经，而感觉仪则通过检查角膜敏感性来提供功能评估的手段。本文探讨了目前对CIPN诊断的指导原则和认识上的差距，以及活体角膜共聚焦显微镜作为诊断或预后工具的潜在作用。还讨论了从动物研究到人类临床研究的神经毒性抗癌药物的角膜神经病理变化，重点讨论了这些数据如何帮助我们理解CIPN。
Survival rates of cancer has improved with the development of anticancer drugs including systemic chemotherapeutic agents. However, long-lasting side effects could impact treated patients. Neurotoxic anticancer drugs are specific agents which cause chemotherapy-induced peripheral neuropathy (CIPN), a debilitating condition that severely deteriorates quality of life of cancer patients and survivors. The ocular surface is also prone to neurotoxicity but investigation into the effects of neurotoxic chemotherapy on the ocular surface has been more limited compared to other systemic etiologies such as diabetes. There is also no standardized protocol for CIPN diagnosis with an absence of a reliable, objective method of observing nerve damage structurally. As the cornea is the most densely innervated region of the body, researchers have started to focus on corneal neuropathic changes that are associated with neurotoxic chemotherapy treatment. In-vivo corneal confocal microscopy enables rapid and objective structural imaging of ocular surface microscopic structures such as corneal nerves, while esthesiometers provide means of functional assessment by examining corneal sensitivity. The current article explores the current guidelines and gaps in our knowledge of CIPN diagnosis and the potential role of invivo corneal confocal microscopy as a diagnostic or prognostic tool. Corneal neuropathic changes with neurotoxic anticancer drugs from animal research progressing through to human clinical studies are also discussed, with a focus on how these data inform our understanding of CIPN.