Sajjad Ahmar, Weng Christina Y
*Baylor College of Medicine, Houston, Texas; and †Cullen Eye Institute, Baylor College of Medicine-Department of Ophthalmology, Houston, Texas.
Retin Cases Brief Rep. 2017;11(4):325-328. doi: 10.1097/ICB.0000000000000355.
To describe a case of bilateral, asymmetrical outer macular atrophy in a patient with pulmonary hypertension treated with long-term sildenafil (Revatio).
Case report with fundus photography, spectral domain optical coherence tomography, fundus autofluorescence, and fluorescein angiography imaging.
A 32-year-old African American woman with a history of primary pulmonary hypertension and 5-year history of oral sildenafil (Revatio) use presented with decreasing central vision in her left eye. She reported a decline in central vision in the left eye that started 1 month after treatment initiation and progressed until discontinuation 5 years later. Visual acuity was 20/20 in the right eye and 20/100 in the left eye. Fundus photography revealed retinal pigment epithelial mottling and atrophy in the right eye and parafoveal retinal pigment epithelial mottling and atrophy in a ring-like configuration of the left eye. Optical coherence tomography demonstrated outer retinal irregularity in the right eye and disrupted outer retina involving the external limiting membrane, inner segment/outer segment junction, and the retinal pigment epithelium in the left eye; no choroidal thickening was observed. Fundus autofluorescence showed mild hypoautofluorescence in the foveal center with an irregular autofluorescence pattern in the parafovea of the left eye. Fluorescein angiography revealed capillary dropout with pinpoint hyperfluorescence and leakage in the far periphery bilaterally. A window defect was also observed in the foveal center of the left eye.
Sildenafil and other PDE5 inhibitors have been associated with several ocular side effects. However, this is the first report in the literature of outer macular atrophy in a patient with pulmonary hypertension and long-term use of oral sildenafil. All patients with long-term use of sildenafil should be educated on the risk of potential visual adverse effects.
描述一例长期使用西地那非（Revatio）治疗肺动脉高压患者出现双侧不对称性黄斑外层萎缩的病例。
通过眼底照相、光谱域光学相干断层扫描、眼底自发荧光和荧光素血管造影成像进行病例报告。
一名32岁的非裔美国女性，有原发性肺动脉高压病史，口服西地那非（Revatio）5年，出现左眼中心视力下降。她报告称，左眼中心视力下降始于治疗开始后1个月，并持续进展，直至5年后停药。右眼视力为20/20，左眼视力为20/100。眼底照相显示右眼视网膜色素上皮斑驳和萎缩，左眼黄斑旁视网膜色素上皮呈环状斑驳和萎缩。光学相干断层扫描显示右眼外层视网膜不规则，左眼外层视网膜破坏，累及外界膜、内节/外节交界处和视网膜色素上皮；未观察到脉络膜增厚。眼底自发荧光显示黄斑中心凹轻度低自发荧光，左眼黄斑旁自发荧光模式不规则。荧光素血管造影显示双侧周边部毛细血管缺失，有针尖样高荧光和渗漏。左眼黄斑中心凹也观察到一个窗样缺损。
西地那非和其他磷酸二酯酶5抑制剂已与多种眼部副作用相关。然而，这是文献中首例肺动脉高压患者长期口服西地那非后出现黄斑外层萎缩的报告。所有长期使用西地那非的患者都应接受有关潜在视觉不良反应风险的教育。
