Santarelli Martina, Zeppieri Marco, Salati Carlo
Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy.
Clin Pract. 2022 May 1;12(3):276-283. doi: 10.3390/clinpract12030033.
(1) Background: Tacrolimus is an immunosuppressive agent commonly used in the management of solid organ allogeneic transplants in the prevention of rejection. Serious ophthalmic adverse effects with Tacrolimus have been reported in the literature, which includes cortical blindness and optic neuropathy. (2) Methods: We describe a rare case of maculopathy as a possible complication of Tacrolimus therapy. A 56-year-old man receiving Tacrolimus for immunosuppression after liver transplantation developed unilateral visual disturbance with a central scotoma. (3) Results: Ophthalmologic examination revealed unilateral maculopathy; a Tacrolimus macular toxicity was suspected. After drug discontinuation, a complete visual recovery was observed; however, the ultrastructural macular damage was irreversible. (4) Conclusions: Reports regarding maculopathy associated with Tacrolimus are limited. This case report adds to the current literature regarding the possible macular toxicity of this immunosuppressive agent, especially if it exceeds therapeutic serum levels. Further data are needed to confirm this possible association. A careful ophthalmologic examination should be promptly performed in patients manifesting visual disturbance while taking Tacrolimus to prevent irreversible, permanent vision loss due to possible drug toxicity.
（1）背景：他克莫司是一种免疫抑制剂，常用于实体器官异体移植的管理以预防排斥反应。文献报道了他克莫司的严重眼部不良反应，包括皮质盲和视神经病变。（2）方法：我们描述了一例罕见的黄斑病变病例，可能是他克莫司治疗的并发症。一名56岁男性在肝移植后接受他克莫司免疫抑制治疗，出现单侧视力障碍并伴有中心暗点。（3）结果：眼科检查发现单侧黄斑病变；怀疑是他克莫司黄斑毒性。停药后，视力完全恢复；然而，黄斑的超微结构损伤是不可逆的。（4）结论：关于他克莫司相关黄斑病变的报道有限。本病例报告为当前有关这种免疫抑制剂可能的黄斑毒性的文献增添了内容，特别是当它超过治疗性血清水平时。需要进一步的数据来证实这种可能的关联。对于服用他克莫司时出现视力障碍的患者，应及时进行仔细的眼科检查，以防止因可能的药物毒性导致不可逆的永久性视力丧失。
