Nebenwirkungen des Virustatikums Cidofovir am Auge

Zusammenfassung

Cidofovir ist ein Virustatikum aus der Gruppe der Nukleotidanaloga mit Wirksamkeit gegen Herpesviren. Hauptindikation ist derzeit die Behandlung der CMV-Retinitis. Neuere Untersuchungen belegen eine zusätzliche Wirksamkeit von Cidofovir bei durch JC-Virus-Reaktivierung verursachter progressiver multifokaler Leukoenzephalopathie (PML). Schwerwiegendste okuläre Komplikation bei Verabreichung von Cidofovir stellt die chronische, therapieresistente Hypotonia bulbi dar, welche durch sekundäre Komplikationen (Makulafalten, Netzhaut-/Aderhautablösung) zu ausgeprägter, permanenter Visusminderung führen kann. Die Entstehung der Drucksenkung ist nicht endgültig geklärt. Eine Behandlung derselben ist nur in Einzelfällen beschrieben worden und in der Effizienz nicht ausreichend gesichert. Als einzig sichere Option bei Auftreten einer Hypotonie verbleibt der Therapiewechsel von Cidofovir auf alternative Substanzen. Zur frühzeitigen Erkennung ophthalmologischer Komplikationen bei Cidofovirtherapie ist eine regelmäßige Kontrolle durch den Augenarzt notwendig.

Abstract

Cidofovir, a nucleotid analogue virostatic drug is effective in the treatment of herpes virus infections. However, cytomegaly infection is the prime indication due to its adverse effects. There is growing evidence suggesting cidofovir's effectiveness against progressive multifocal leukoencephalopathy (PML) caused by a reactivation of JC-virus. Chronic ocular hypotension which seems to be therapy refractory and anterior uveitis are considered to be the most serious ocular complications of cidofovir. Secondary side effects such as macular folds, retinal or choroidal detachment can result in a permanent loss of vision. Little is known about the pathology of reduced intraocular pressure and only few reports deal with therapeutical attempts to compensate this complication. Abandoning cidofovir presently remains the only therapeutic option. To avoid serious damage it is of utmost importance to monitor all patients undergoing cidofovir administration for signs of anterior uveitis and ocular hypotension.

Schlüsselwörter

Cidofovir - Hypotonia bulbi - Uveitis anterior - progressive multifokale Leukoenzephalopathie (PML) - CMV-Retinitis

Key words

Cidofovir - ocular hypotension - anterior uveitis - progressive multifocal leukoencephalopathy (PML) - cytomegalovirus retinitis

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