Retinal and Ocular Toxicity in Ocular Application of Drugs and Chemicals - Part II: Retinal Toxicity of Current and New Drugs

Retinal and Ocular Toxicity in Ocular Application of Drugs and Chemicals - Part II: Retinal Toxicity of Current and New Drugs

Author Penha, Fernando Marcondes Autor UNIFESP Google Scholar
Rodrigues, Eduardo Buchele Autor UNIFESP Google Scholar
Maia, Mauricio Autor UNIFESP Google Scholar
Furlani, Bruno de Alburquerque Autor UNIFESP Google Scholar
Regatieri, Caio Vinicius Saito Autor UNIFESP Google Scholar
Melo, Gustavo Barreto de Autor UNIFESP Google Scholar
Magalhães, Octaviano Autor UNIFESP Google Scholar
Manzano, Roberta Autor UNIFESP Google Scholar
Farah, Michel Eid Autor UNIFESP Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Abstract Aims: Retinal pharmacotherapy has gained great importance for the treatment of various retinal diseases. An increasing number of drugs have been constantly released into the market, especially for wet age-related macular disease and diabetic macular edema. in this review, the issues concerning the toxicity of current and new classes of drugs are discussed. Methods: An extensive search of the literature was performed to review various aspects of drug toxicity in retinal pharmacotherapy. the different major classes of drugs, such as corticosteroids, antibiotics, antimetabolites, antineoplastic agents, monoclonal antibodies (mAbs), nonsteroidal anti-inflammatory drugs, enzymes, fibrinolytics, miscellaneous anti-inflammatory and antiangiogenic agents, as well as toxicity unrelated to the drug were identified and discussed. Results: Corticosteroids like fluocinolone, dexamethasone or triamcinolone at low dose cause little damage to the retina, but at high doses signs of toxicity have been well documented. Complications like cataract and glaucoma are quite common with corticosteroids. Aminoglycosides showed differences in the type and doses associated with toxic reactions, thereby the following order of toxicity can be described (from most toxic to least toxic): gentamicin > netilmicin = tobramycin > amikacin = kanamycin. Vancomycin at the usual dose of 1 mg is not toxic to the retina, while further studies are necessary in order to clarify the safety of new-generation quinolones. 5-Fluorouracil has been shown to be nontoxic to the retina after an injection of 2.5 mg in animals. mAbs like ranibizumab and bevacizumab were demonstrated to be safe to the retina in cell culture, animals and humans at high doses. the exact biocompatibility of nonsteroidal anti-inflammatory agents like diclofenac needs further evaluation. Preservatives like benzyl alcohol and changes in pH or osmolarity exert an influence on the toxic effects of intravitreally applied drugs. Conclusions: A great number of drugs are now used mainly intravitreally without relevant retinal toxicity. Copyright (C) 2010 S. Karger AG, Basel
Keywords Avastin
Lucentis
Retina
Bevacizumab
Ranibizumab
Monoclonal antibodies
Tumor necrosis factor
Vascular endothelial growth factor
Corticosteroids
Antimetabolites
Triamcinolone
Nonsteroidal anti-inflammatory drugs
Microplasmin
Language English
Date 2010-01-01
Published in Ophthalmic Research. Basel: Karger, v. 44, n. 4, p. 205-224, 2010.
ISSN 0030-3747 (Sherpa/Romeo, impact factor)
Publisher Karger
Extent 205-224
Origin http://dx.doi.org/10.1159/000316695
Access rights Open access Open Access
Type Review
Web of Science ID WOS:000280932000001
URI http://repositorio.unifesp.br/handle/11600/32037

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