Capabilities of cytostatic agents usage in ophthalmology

Abstract

Antineoplastic drugs are increasingly used in the treatment of diseases of the vision organ. However, practicing ophthalmologists often deal with lack of information about the choice of drugs with anticancer effect, their mechanism of action, dosage, route of administration, potential side effects including their prevention. Mechanism of action is presented for the most commonly used immunosuppressants in ophthalmology (such as metabolic antagonists, alkylation agents, antineoplastic antibiotics, monoclonal antibodies). Efficiency and routes of administration are described for cytostatics used for the treatment of intraocular tumors (retinoblastoma), for prevention and treatment of proliferative syndrome in ophthalmosurgery complicating the surgery for glaucoma, pterigium and refractive corneal procedures, and presenting the pathogenetic basis of proliferative vitreoretinopathy and posterior lens capsule opacity. Possible local side effects of immunosupressors in ocular surgery are presented (epithelial and suture defects, hemorrhagic choroidal detachment, cataract progression, endophthalmitis, malignant glaucoma, toxic effect on the ciliary body, keratopathy, hypertensive maculopathy). Also, the issue of the use of cytostatics and immunodepressants for acute and chronic inflammatory eye diseases is discussed (for example, for uveitis, filamentary ke­ratitis, allergic blepharoconjunctivitis, allergic conjunctivitis and spring ophthalmia, adenoviral keratoconjunctivitis, rosacea keratitis, ocular pemphigoid, recurrent chalazion, scleritis, episcleritis, painful bullous keratopathy, state after keratoplasty and refractive surgery of ocular fibrous capsule). Special attention was paid to the eye neovascularization and common use of intravitreal injections of monoclonal antibodies (ranibizumab, aflibercept) for premature infants’ retinopathy, choroidal neovascularization of various origin (in trauma, myopia, histoplasmosis), neovascular form of age-related macular dystrophy, secondary neovascular glaucoma, proliferative diabetic retinopathy and diabetic macular edema. Need for search of new more effective and safe medicines with antineoplastic and immunodepressive action is emphasized for ophthalmology, eye surgery and medicine in general.

An easy and safe method of subconjunctival injection of antimetabolites in glaucoma surgery

“…Modifications in surgical technique, the use of various drainage, shunt, and valve devices as well as specific methods of pharmacological modification of the healing process are currently addressing the problem of prolonging the hypotensive effect of antiglaucoma surgery [1][2][3][4]. In particular, the use of antimetabolites in glaucoma surgery has found wide application both as intraoperative treatment and as postoperative injections, reliably reducing the risk of scleral scarring in the surgical zone [5][6][7]. The main drugs used for this purpose are mitomycin C and 5-fluorouracil (5-FU).…”