Nanda Tavish, Rasool Nailyn, Bearelly Srilaxmi
Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, United States.
Department of Neuro-Ophthalmology, University of California, San Francisco, CA, United States.
Am J Ophthalmol Case Rep. 2021 Mar 11;22:101056. doi: 10.1016/j.ajoc.2021.101056. eCollection 2021 Jun.
Tacrolimus is a commonly used immunosuppressant medication after lung transplantation. In rare cases, tacrolimus causes a medication-induced optic neuropathy (TON) that can lead to significant vision loss.
In this series, we describe three cases of TON, 1-10 years after medication use. Two patients were young (22yr and 33yr) females with cystic fibrosis. The last case was a 65yr male with idiopathic pulmonary fibrosis. In 2/3 cases tacrolimus serum levels were normal. Visual acuity ranged from 20/20 to 20/300, and vision loss occurred acutely to sub-acutely, over a span of 2-3 months.
As presented here, TON can be highly variable. MRI findings are often non-specific, from normal brain findings to extensive white matter changes. There remains an unclear association with graft-versus-host disease and reduced kidney function. Visual findings are often subtle, including color vision aberration and peripheral visual field deficits, both of which usually require an ophthalmologic evaluation. When diagnosed in a timely fashion, TON is at least partially reversible in up to half of all cases. While rare, the cases described here support post-lung transplant ophthalmologic evaluation in those taking high-risk medications.
他克莫司是肺移植后常用的免疫抑制药物。在罕见情况下，他克莫司会导致药物性视神经病变（TON），可导致严重视力丧失。
在本系列研究中，我们描述了3例用药后1至10年发生TON的病例。其中2例为年轻（22岁和33岁）患有囊性纤维化的女性患者。最后1例是1名65岁患有特发性肺纤维化的男性患者。2/3的病例中他克莫司血清水平正常。视力范围为20/20至20/300，视力丧失在2至3个月内急性至亚急性发生。
如本文所述，TON的表现可能高度多变。MRI检查结果通常不具有特异性，从正常脑部表现到广泛的白质改变。与移植物抗宿主病和肾功能降低之间的关联仍不明确。视觉表现通常较为隐匿，包括色觉异常和周边视野缺损，这两者通常都需要眼科评估。若能及时诊断，TON在多达一半的病例中至少部分可逆。虽然罕见，但本文所述病例支持对服用高风险药物的肺移植受者进行眼科评估。
