C L I N I C A L
A N D
E X P E R I M E N T A L
OPTOMETRY CINICAL PICTURE
Central serous chorioretinopathy following oral tadalafil intake Clin Exp Optom 2014; 97: 473–474
DOI:10.1111/cxo.12141
Rupak Roy MS Pradeep Kumar Panigrahi MS Kumar Saurabh MS Debmalya Das DNB Aneesha Lobo MS Vitreo Retina services, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India E-mail: [email protected]
Submitted: 15 October 2013 Revised: 26 November 2013 Accepted for publication: 2 December 2013
Figure 1. A. Fundus photograph of the right eye showing a pocket of subretinal fluid (arrow heads) over the posterior pole. B. Optical coherence tomographic scans passing through the posterior pole showing significant subretinal fluid.
We report a case of central serous chorioretinopathy following the use of tadalafil, an oral phosphodiesterase 5 (PDE5) inhibitor for erectile dysfunction.
CASE REPORT A 45-year-old healthy man presented to us with the complaints of sudden painless loss of vision in his right eye of 10 days duration. Visual acuity was 6/60, N24 in the right eye and 6/6, N6 in the left eye. Anterior segment examination was within normal limits. Fundus examination showed a large neurosensory retinal detachment at the macula. The left macula had no visible changes. Optical coherence tomography confirmed a large sensory detachment in the right eye and no abnormalities in the left eye (Figure 1). There was no abnormality at the level of the retinal pigment epithelium in either eye. The left eye was within normal limits. The patient gave a history of taking oral tadalafil for erectile dysfunction five days prior to his visual problems. There was no history of corticosteroid use in any form and he did not have any specific personality trait. Our diagnosis was central serous chorioretinopathy associated with tadalafil use. The patient was advised to stop tadalafil and to return after one month. On review, the
Figure 2. A. Fundus photograph of right eye after one month showing almost complete resolution of the subretinal fluid. B. Optical coherence tomographic scan showing minimal subretinal fluid.
patient’s visual acuity had returned to 6/6 and N6. Optical coherence tomographic scans confirmed a significant flattening of the detachment and reduction of subretinal fluid to a minimal level (Figure 2).
DISCUSSION PDE5 inhibitors like sildenafil citrate, tadalafil and vardenafil are being prescribed rou-
© 2014 The Authors Clinical and Experimental Optometry © 2014 Optometrists Association Australia
tinely to treat erectile dysfunction. PDE5 inhibitors act by blocking the action of the PDE5 on the cyclic guanosine monophosphate lining the blood vessels. PDE5 inhibitors also modify the action of PDE5 present in the retinal and choroidal circulation. There have been recent reports linking tadalafil use to the occurrence of central serous chorioretinopathy. Gordon-Bennett and Rimmer1 reported a case of central serous chorioretinopathy in a 51-year-old
Clinical and Experimental Optometry 97.5 September 2014
473
Chorioretinopathy after tadalafil Roy, Panigrahi, Saurabh, Das and Lobo
man. The patient complained of blurring of vision of his left eye within 24 hours of intake of tadalafil. Visual acuity improved within five days of discontinuing tadalafil. Nadeau, Nguyen and Guigou2 and Turkcu et al.3 also reported cases of central serous chorioretinopathy following tadalafil. Both Gordon-Bennett and Rimmer1 and Turkcu et al.3 reported unilateral involvement. In their prospective study on 43 patients using sildenafil citrate, Damar et al.4 did not find a single case of central serous chorioretinopathy. Our case report adds to the body of evidence available showing a possible association between oral intake of tadalafil and the occurrence of central serous chorioretinopathy. We are unsure if the occurrence of central serous chorioretinopathy following tadalafil intake is dose-related or idiosyncratic. A positive challenge and rechallenge test would have been ideal to prove a causal relationship; however, it was not possible because of ethical and logistical reasons. Further large randomised trials are required before a final conclusion is reached. Our patient showed dramatic improvement following stoppage of the drug intake. Most cases of central serous chorioretinopathy remain idiopathic. A proper drug intake history should always be obtained in otherwise healthy young adults. An enquiry regarding the use of PDE5 inhibitor can sometimes bear fruitful results in healthy adults presenting with central serous chorioretinopathy. REFERENCES 1. Gordon-Bennett P, Rimmer T. Central serous chorioretinopathy following oral tadalafil. Eye (Lond) 2012; 26: 168–169. 2. Nadeau S, Nguyen F, Guigou S. Serous central chorioretinopathy and tadalafil: a case report. J Fr Ophtalmol 2012; 35: 121. 3. Turkcu FM, Yuksel H, Sahin A, Murat M, Bozkurt Y, Caca I. Central serous chorioretinopathy due to tadalafil use. Int Ophthalmol 2013; 33: 177–180. 4. Damar E, Toklu Y, Tuncel A, Balci M, Aslan Y, Simsek S, Atan A. Does therapeutic dose of sildenafil citrate treatment lead to central serous chorioretinopathy in patients with erectile dysfunction? Am J Mens Health 2013; 7: 439–443.
Clinical and Experimental Optometry 97.5 September 2014
474
© 2014 The Authors Clinical and Experimental Optometry © 2014 Optometrists Association Australia
A N D
E X P E R I M E N T A L
OPTOMETRY CINICAL PICTURE
Central serous chorioretinopathy following oral tadalafil intake Clin Exp Optom 2014; 97: 473–474
DOI:10.1111/cxo.12141
Rupak Roy MS Pradeep Kumar Panigrahi MS Kumar Saurabh MS Debmalya Das DNB Aneesha Lobo MS Vitreo Retina services, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India E-mail: [email protected]
Submitted: 15 October 2013 Revised: 26 November 2013 Accepted for publication: 2 December 2013
Figure 1. A. Fundus photograph of the right eye showing a pocket of subretinal fluid (arrow heads) over the posterior pole. B. Optical coherence tomographic scans passing through the posterior pole showing significant subretinal fluid.
We report a case of central serous chorioretinopathy following the use of tadalafil, an oral phosphodiesterase 5 (PDE5) inhibitor for erectile dysfunction.
CASE REPORT A 45-year-old healthy man presented to us with the complaints of sudden painless loss of vision in his right eye of 10 days duration. Visual acuity was 6/60, N24 in the right eye and 6/6, N6 in the left eye. Anterior segment examination was within normal limits. Fundus examination showed a large neurosensory retinal detachment at the macula. The left macula had no visible changes. Optical coherence tomography confirmed a large sensory detachment in the right eye and no abnormalities in the left eye (Figure 1). There was no abnormality at the level of the retinal pigment epithelium in either eye. The left eye was within normal limits. The patient gave a history of taking oral tadalafil for erectile dysfunction five days prior to his visual problems. There was no history of corticosteroid use in any form and he did not have any specific personality trait. Our diagnosis was central serous chorioretinopathy associated with tadalafil use. The patient was advised to stop tadalafil and to return after one month. On review, the
Figure 2. A. Fundus photograph of right eye after one month showing almost complete resolution of the subretinal fluid. B. Optical coherence tomographic scan showing minimal subretinal fluid.
patient’s visual acuity had returned to 6/6 and N6. Optical coherence tomographic scans confirmed a significant flattening of the detachment and reduction of subretinal fluid to a minimal level (Figure 2).
DISCUSSION PDE5 inhibitors like sildenafil citrate, tadalafil and vardenafil are being prescribed rou-
© 2014 The Authors Clinical and Experimental Optometry © 2014 Optometrists Association Australia
tinely to treat erectile dysfunction. PDE5 inhibitors act by blocking the action of the PDE5 on the cyclic guanosine monophosphate lining the blood vessels. PDE5 inhibitors also modify the action of PDE5 present in the retinal and choroidal circulation. There have been recent reports linking tadalafil use to the occurrence of central serous chorioretinopathy. Gordon-Bennett and Rimmer1 reported a case of central serous chorioretinopathy in a 51-year-old
Clinical and Experimental Optometry 97.5 September 2014
473
Chorioretinopathy after tadalafil Roy, Panigrahi, Saurabh, Das and Lobo
man. The patient complained of blurring of vision of his left eye within 24 hours of intake of tadalafil. Visual acuity improved within five days of discontinuing tadalafil. Nadeau, Nguyen and Guigou2 and Turkcu et al.3 also reported cases of central serous chorioretinopathy following tadalafil. Both Gordon-Bennett and Rimmer1 and Turkcu et al.3 reported unilateral involvement. In their prospective study on 43 patients using sildenafil citrate, Damar et al.4 did not find a single case of central serous chorioretinopathy. Our case report adds to the body of evidence available showing a possible association between oral intake of tadalafil and the occurrence of central serous chorioretinopathy. We are unsure if the occurrence of central serous chorioretinopathy following tadalafil intake is dose-related or idiosyncratic. A positive challenge and rechallenge test would have been ideal to prove a causal relationship; however, it was not possible because of ethical and logistical reasons. Further large randomised trials are required before a final conclusion is reached. Our patient showed dramatic improvement following stoppage of the drug intake. Most cases of central serous chorioretinopathy remain idiopathic. A proper drug intake history should always be obtained in otherwise healthy young adults. An enquiry regarding the use of PDE5 inhibitor can sometimes bear fruitful results in healthy adults presenting with central serous chorioretinopathy. REFERENCES 1. Gordon-Bennett P, Rimmer T. Central serous chorioretinopathy following oral tadalafil. Eye (Lond) 2012; 26: 168–169. 2. Nadeau S, Nguyen F, Guigou S. Serous central chorioretinopathy and tadalafil: a case report. J Fr Ophtalmol 2012; 35: 121. 3. Turkcu FM, Yuksel H, Sahin A, Murat M, Bozkurt Y, Caca I. Central serous chorioretinopathy due to tadalafil use. Int Ophthalmol 2013; 33: 177–180. 4. Damar E, Toklu Y, Tuncel A, Balci M, Aslan Y, Simsek S, Atan A. Does therapeutic dose of sildenafil citrate treatment lead to central serous chorioretinopathy in patients with erectile dysfunction? Am J Mens Health 2013; 7: 439–443.
Clinical and Experimental Optometry 97.5 September 2014
474
© 2014 The Authors Clinical and Experimental Optometry © 2014 Optometrists Association Australia
