Alizadeh Yousef, Moravvej Zahra, Khakpour Yaser, Azaripour Ebrahim, Akbari Mitra, Soltani-Moghadam Reza
Department of Eye, Eye Research Center, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
Int J Reprod Biomed. 2021 Jun 23;19(5):471-476. doi: 10.18502/ijrm.v19i5.9257. eCollection 2021 May.
Clomiphene citrate is an estrogen receptor ligand with mixed agonistic-antagonistic properties used for the treatment of female and male infertility. Various visual disturbances and several irreversible visual outcomes have been associated with clomiphene citrate. In this report, we present a patient with presumed clomiphene-induced optic neuropathy.
A 33-yr-old man with acute visual loss of the right eye was referred to Amiralmomenin Hospital, Rasht, Iran in November 2018. His only medication was clomiphene citrate 100 mg daily, taken for 2 wk for fertility issues. The patient presented with a sudden decrease of visual acuity in the right eye on the 14 day of starting the treatment and subsequently developed complete loss of inferior visual field within a few days. On examination, the visual acuity was 6/20 in the right and 20/20 in the left eyes, with a right relative afferent pupillary defect and decreased red color saturation. The fundus examination revealed optic disc swelling with venous dilation in the right eye and a normal left fundus with a crowded disc (disc-at-risk). The patient was evaluated for systemic disorders, all of which were normal. Findings were suggestive of non-arteritic anterior ischemic optic neuropathy most likely due to clomiphene.
As clomiphene may increase blood viscosity, it is hypothesized that reduced flow in a posterior ciliary artery in conjunction with the disc-at-risk contributes to the anterior ischemic optic neuropathy. It is advised that patients with disc-at-risk be aware of the possible non-arteritic anterior ischemic optic neuropathy and those experiencing visual symptoms while taking clomiphene be examined promptly for evidence of optic nerve injury.
枸橼酸氯米芬是一种具有混合激动 - 拮抗特性的雌激素受体配体，用于治疗女性和男性不孕症。枸橼酸氯米芬已被证实与各种视觉障碍及多种不可逆的视觉后果有关。在本报告中，我们介绍了一名疑似因枸橼酸氯米芬导致视神经病变的患者。
一名33岁男性，于2018年11月因右眼急性视力丧失被转诊至伊朗拉什特的阿米尔阿尔莫梅宁医院。他唯一服用的药物是每日100毫克的枸橼酸氯米芬，因生育问题服用了2周。患者在开始治疗的第14天出现右眼视力突然下降，随后在几天内右眼下方视野完全丧失。检查发现，右眼视力为6/20，左眼视力为20/20，右眼有相对传入性瞳孔障碍，红色饱和度降低。眼底检查显示右眼视盘肿胀伴静脉扩张，左眼眼底正常，但视盘拥挤（有风险的视盘）。对患者进行了全身性疾病评估，结果均正常。检查结果提示最可能是由枸橼酸氯米芬引起的非动脉性前部缺血性视神经病变。
由于枸橼酸氯米芬可能会增加血液粘度，因此推测睫状后动脉血流减少与有风险的视盘共同作用导致了前部缺血性视神经病变。建议有风险视盘的患者了解可能发生的非动脉性前部缺血性视神经病变，并且服用枸橼酸氯米芬期间出现视觉症状的患者应立即接受检查，以确定是否存在视神经损伤的迹象。
