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. 2018 Fall;12 Suppl 1(Suppl 1):S33-S40.
doi: 10.1097/ICB.0000000000000708.

SILDENAFIL CITRATE INDUCED RETINAL TOXICITY-ELECTRORETINOGRAM, OPTICAL COHERENCE TOMOGRAPHY, AND ADAPTIVE OPTICS FINDINGS

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Free PMC article
Case Reports

SILDENAFIL CITRATE INDUCED RETINAL TOXICITY-ELECTRORETINOGRAM, OPTICAL COHERENCE TOMOGRAPHY, AND ADAPTIVE OPTICS FINDINGS

Fatoumata Yanoga et al. Retin Cases Brief Rep. .
Free PMC article

Abstract

Background/purpose: To report a case of persistent retinal toxicity associated with a high dose of sildenafil citrate intake.

Methods: Single retrospective case report.

Results: A 31-year-old white man with no medical history presented with complaints of bilateral multicolored photopsias and erythropsia (red-tinted vision), shortly after taking sildenafil citrate-purchased through the internet. Patient was found to have cone photoreceptor damage, demonstrated using electroretinogram, optical coherence tomography, and adaptive optics imaging. The patient's symptoms and the photoreceptor structural changes persisted for several months.

Conclusion: Sildenafil citrate is a widely used erectile dysfunction medication that is typically associated with transient visual symptoms in normal dosage. At high dosage, sildenafil citrate can lead to persistent retinal toxicity in certain individuals.

Figures

Figure 1
Figure 1
A, B. Ultra-wide-field color images suggest subtle pigment mottling in the macula, with unremarkable vascular networks, optic nerves, and retinal periphery. C, D. Ultra-wide-field fluorescein angiography shows normal filling and no leakage. E, F. Fundus autofluorescence demonstrates symmetric areas of hyperautofluorescence slightly temporal to the fovea in both eyes
Figure 2
Figure 2
A, C. Near-infrared reflectance shows a bullseye pattern with concentric rings of hypo- and hyperreflectivity in both eyes. B, D. Optical coherence tomography B-scans show a diffused nodular thickening and irregularities of the central ellipsoid zone associated with thinning and poor delineation of the inter-digitation zone in both eyes. The choroid appears thickened in both eyes
Figure 3
Figure 3
A. Full-field ERG shows reduced cone amplitudes, normal rod responses, and normal implicit times in both eyes. B. Multi-focal ERG shows reduced amplitudes throughout the macula in both eyes
Figure 4
Figure 4
Adaptive optics scanning light ophthalmoscope images of the patient reveal multiple dark spots in the cones mosaic, not seen in the controls, consistent with loss or non-waveguiding photoreceptors at increasing eccentricities from the foveal center in both eyes (0.5, 3, 5, 7 degrees from Umbo).
Figure 5
Figure 5
En face OCT angiography (OCT-A) of the central 3×3 mm taken at 1-week follow-up shows normal microvasculature in the right eye (A, B, C) and the left eye (D, E, F). A and D are segmented at the level of the superficial retinal capillary plexus. B and E are segmented at the level of the deep retinal capillary plexus. C and F are segmented at the level of the choriocapillaris.
Figure 6
Figure 6. Examination 3 months following presentation
A, C. Near infrared reflectance (NIR) of the right eye (A) and the left eye (C) B, D. The OCT B-scans at the level of the corresponding area on panels A and C (green lines) evidence partial restoration of the ellipsoid zone with residual mottling. E, F. The optic nerve OCT scans demonstrate normal nerve fiber layer thickness in both eyes.

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