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Brossard-Barbosa N, Williams ZR. Nonarteritic Anterior Ischemic Optic Neuropathy After Recreational PDE5 Inhibitor Use in a Healthy Patient: More Evidence for Causation. J Neuroophthalmol 2024:00041327-990000000-00624. [PMID: 38637932 DOI: 10.1097/wno.0000000000002159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Affiliation(s)
- Natalie Brossard-Barbosa
- Department of Ophthalmology (NB-B, ZRW), University of Rochester School of Medicine, Flaum Eye Institute, Rochester, New York; and Departments of Neurosurgery (ZRW) and Neurology (ZRW), University of Rochester School of Medicine, Rochester, New York
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Arora S, Surakiatchanukul T, Arora T, Cagini C, Lupidi M, Chhablani J. Sildenafil in ophthalmology: An update. Surv Ophthalmol 2021; 67:463-487. [PMID: 34175342 DOI: 10.1016/j.survophthal.2021.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 06/18/2021] [Accepted: 06/21/2021] [Indexed: 12/14/2022]
Abstract
Sildenafil citrate, a selective oral phosphodiesterase 5 inhibitor, is a widely used drug for erectile dysfunction that acts by elevating cGMP levels and causing smooth muscle relaxation. It also has 10% activity against PDE6, a key enzyme in phototransduction cascade in the retina. Recent ocular imaging developments have further revealed the influence of sildenafil on ocular hemodynamics, particularly choroidal perfusion. Choroidal thickness is increased, and choroidal perfusion is also enhanced by autoregulatory mechanisms that are further dependent on age and microvascular abnormalities. Studies demonstrating high intraocular pressure via a "parallel pathway" from increased choroidal volume and blood flow to the ciliary body have challenged previous concepts. Another new observation is the effect of sildenafil on bipolar cells and cyclic-nucleotide gated channels. We discuss potential deleterious effects (central serous chorioretinopathy, glaucoma, ischemic optic neuropathy, and risks to recessive carriers of retinitis pigmentosa), potential beneficial effects (ameliorate choroidal ischemia, prevent thickening of Bruch membrane, and promote recovery of the ellipsoid zone) in macular degeneration, as well as potential drug interactions of sildenafil.
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Affiliation(s)
- Supriya Arora
- Bahamas Vision Centre and Princess Margaret Hospital, Nassau NP, Bahamas.
| | - Thamolwan Surakiatchanukul
- Department of Ophthalmology, Jamaica Hospital Medical Center, New York Medical College, Jamaica, NY, USA
| | - Tarun Arora
- Bahamas Vision Centre and Princess Margaret Hospital, Nassau NP, Bahamas.
| | - Carlo Cagini
- Department of Biochemical and Surgical Sciences, Section of ophthalmology, University of Perugia, Perugia, Italy
| | - Marco Lupidi
- Department of Biochemical and Surgical Sciences, Section of ophthalmology, University of Perugia, Perugia, Italy
| | - Jay Chhablani
- University of Pittsburgh, UPMC Eye Center, Pittsburgh, PA, USA.
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Barroso F, Ribeiro JC, Miranda EP. Phosphodiesterase Type 5 Inhibitors and Visual Side Effects: A Narrative Review. J Ophthalmic Vis Res 2021; 16:248-259. [PMID: 34055262 PMCID: PMC8126729 DOI: 10.18502/jovr.v16i2.9088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 11/10/2020] [Indexed: 11/24/2022] Open
Abstract
Phosphodiesterase type 5 inhibitors such as sildenafil citrate and tadalafil are well known for the treatment of erectile dysfunction. However, their use in the presence of pulmonary hypertension can cause ophthalmologic side effects, including non-arteritic optic ischemic neuropathy, chorioretinopathy, glaucoma, and optic atrophy. The present review aimed to identify these visual side effects and provide recommendations. We identified articles published from January 2000 to March 2019 on diseases arising from the management of sexual dysfunction in urology or pulmonary hypertension in pneumonia that could cause pathologic alterations in eye structure based on a literature search of the MEDLINE electronic database using keywords for the most common adverse effects and different kinds of phosphodiesterase 5 inhibitors. After applying the exclusion criteria, we selected 36 of the 77 articles initially identified to write the narrative review and added 20 additional articles to completely describe the pathological entities. Phosphodiesterase type 5 inhibitors can cause side effects in the eye including ocular surface abnormalities, increased intraocular pressure and glaucoma, uveitis, non-arteritic ischemic neuropathy, chorioretinopathy, retinal occlusion, and visual field changes. There is an increased need for well-performed studies to better understand these side effects, which are common due to the wide use of sildenafil.
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Visual Side Effects Linked to Sildenafil Consumption: An Update. Biomedicines 2021; 9:biomedicines9030291. [PMID: 33809319 PMCID: PMC7998971 DOI: 10.3390/biomedicines9030291] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 12/14/2022] Open
Abstract
Phosphodiesterase type 5 (PDE5) inhibitors such as Viagra® (sildenafil citrate) have demonstrated efficacy in the treatment of erectile dysfunction (ED) by inducing cyclic guanosine monophosphate (cGMP) elevation followed by vasodilation and increased blood flow. It also exerts minor inhibitory action against PDE6, which is present exclusively in rod and cone photoreceptors. The effects of sildenafil on the visual system have been investigated in a wide variety of clinical and preclinical studies due to the fact that a high dose of sildenafil may cause mild and transient visual symptoms in some patients. A literature review was performed using PubMed, Cochrane Library and Clinical Trials databases from 1990 up to 2020, focusing on the pathophysiology of visual disorders induced by sildenafil. The aim of this review was not only to gather and summarize the information available on sildenafil clinical trials (CTs), but also to spot subpopulations with increased risk of developing undesirable visual side effects. This PDE inhibitor has been associated with transient and reversible ocular side effects, including changes in color vision and light perception, blurred vision, photophobia, conjunctival hyperemia and keratitis, and alterations in the electroretinogram (ERG). Sildenafil may induce a reversible increase in intraocular pressure (IOP) and a few case reports suggest it is involved in the development of nonarteritic ischemic optic neuropathy (NAION). Reversible idiopathic serous macular detachment, central serous retinopathy and ERG disturbances have been related to the significant impact of sildenafil on retinal perfusion. So far, sildenafil does not seem to cause permanent toxic effects on chorioretinal tissue and photoreceptors as long as the therapeutic dose is not exceeded and is taken under a physician’s direction to treat a medical condition. However, the recreational use of sildenafil can lead to harmful side effects, including vision changes.
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Progressive Effects of Sildenafil on Visual Processing in Rats. Neuroscience 2020; 441:131-141. [PMID: 32615234 DOI: 10.1016/j.neuroscience.2020.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/26/2020] [Accepted: 06/23/2020] [Indexed: 10/24/2022]
Abstract
Photoreceptors are light-sensitive cells in the retina converting visual stimuli into electrochemical signals. These signals are evaluated and interpreted in the visual pathway, a process referred to as visual processing. Phosphodiesterase type 5 and 6 (PDE5 and 6) are abundant enzymes in retinal vessels and notably photoreceptors where PDE6 is exclusively present. The effects of the PDE inhibitor sildenafil on the visual system, have been studied using electroretinography and a variety of clinical visual tasks. Here we evaluate effects of sildenafil administration by electrophysiological recordings of flash visual evoked potentials (VEPs) and steady-state visual evoked potentials (SSVEPs) from key regions in the rodent visual pathway. Progressive changes were investigated in female Sprague-Dawley rats at 10 timepoints from 30 min to 28 h after peroral administration of sildenafil (50 mg/kg). Sildenafil caused a significant reduction in the amplitude of VEPs in both visual cortex and superior colliculus, and a significant delay of the VEPs as demonstrated by increased latency of several VEP peaks. Also, sildenafil-treatment significantly reduced the signal-to-noise ratio of SSVEPs. The effects of sildenafil were dependent on the wavelength condition in both assays. Our results support the observation that while PDE6 is a key player in phototransduction, near full inhibition of PDE6 is not enough to abolish the complex process of visual processing. Taken together, VEPs and SSVEPs are effective in demonstrating progressive effects of drug-induced changes in visual processing in rats and as the same paradigms may be applied in humans, representing a promising tool for translational research.
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Shehata NAA, Ali HAA, Fahim AS, Katta MA, Hussein GK. Addition of sildenafil citrate for treatment of severe intrauterine growth restriction: a double blind randomized placebo controlled trial. J Matern Fetal Neonatal Med 2020; 33:1631-1637. [PMID: 30345864 DOI: 10.1080/14767058.2018.1523892] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 09/11/2018] [Indexed: 10/28/2022]
Abstract
Background: Severe intrauterine growth restriction complicates approximately 0.4% of the pregnancies. It increases the risk of perinatal morbidity and mortality.Subjects and methods: A double blind placebo controlled trial was conducted in Beni Suef University hospitals during 2017. It included 46 pregnant women with severe intrauterine growth restriction. Women were randomly allocated into two groups each included 23 patients. Intervention group received sildenafil citrate 20 mg orally three times a day, in addition to fish oil and zinc supplementation. Control group received tablets similar to sildenafil and the same treatment as intervention group. Primary outcomes included improvement in umbilical and middle cerebral arteries pulsatility indices and abdominal circumference.Results: Umbilical and middle cerebral arteries Doppler indices showed significant difference between groups after intake of sildenafil. Umbilical artery pulsatility index decreased significantly (p value = .001) while middle cerebral artery pulsatility index increased significantly in intervention group (p value0.001). Moreover, abdominal circumference growth velocity improved after two weeks of sildenafil intake (p value = .001).Conclusions: Sildenafil citrate may improve uteroplacental and fetal cerebral perfusion in pregnancies complicated by severe intrauterine growth restriction. It also improves abdominal circumference growth velocity. A wide scale randomized trials are needed for evaluation of neonatal and long term morbidity and mortality outcomes of pregnancies treated by sildenafil citrate.
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Affiliation(s)
| | - Hamada A A Ali
- Department of Obstetrics and Gynecology, Beni-Suef University, Cairo, Egypt
| | - Ashraf S Fahim
- Department of Obstetrics and Gynecology, Beni-Suef University, Cairo, Egypt
| | - Maha A Katta
- Department of Obstetrics and Gynecology, Beni-Suef University, Cairo, Egypt
| | - Gaber K Hussein
- Department of Obstetrics and Gynecology, Beni-Suef University, Cairo, Egypt
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Monitor recipients of phosphodiesterase type 5 inhibitors for glaucoma, pending more clinical evidence of risk. DRUGS & THERAPY PERSPECTIVES 2020. [DOI: 10.1007/s40267-020-00709-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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8
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[Chorioretinal folds of interesting etiology]. Ophthalmologe 2020; 117:1234-1238. [PMID: 32108250 DOI: 10.1007/s00347-020-01057-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Precautions and Monitoring of Patients Taking Phosphodiesterase Type 5 Inhibitors Who are at Risk of Increased Intraocular Pressure. Drugs Aging 2020; 36:991-997. [PMID: 31435912 DOI: 10.1007/s40266-019-00699-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Phosphodiesterase type 5 inhibitors (PDE5Is) may increase intraocular pressure (IOP) by increasing blood flow to the ciliary body. Although clinical studies of changes in IOP after single and multiple doses of PDE5Is show variable results, most are limited by small sample sizes, absence of control groups and blinding, and use of normal patient volunteers who have no risk factors for glaucoma. However, multiple case reports of glaucoma have been published, and one epidemiologic analysis of the National Health and Nutrition Examination Survey (NHANES) database of US respondents suggested a significant association of prolonged sildenafil use and self-reported glaucoma. With the widespread use of PDE5Is for treatment of erectile dysfunction in males with risk factors for glaucoma, and the potential of PDE5Is to worsen optic nerve damage in patients with glaucoma, we recommend a vision screening exam prior to the initiation of the PDE5I and careful follow-up thereafter, particularly if the patient is taking tadalafil, a long-acting PDE5I, if the patient is taking high doses of a PDE5I daily and persistently, and if the patient has risk factors for glaucoma or if the patient is at risk of worsening glaucoma.
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Ocular manifestations of pulmonary hypertension. Surv Ophthalmol 2019; 64:694-699. [DOI: 10.1016/j.survophthal.2019.02.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/22/2019] [Accepted: 02/25/2019] [Indexed: 11/30/2022]
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Wareham LK, Dordea AC, Schleifer G, Yao V, Batten A, Fei F, Mertz J, Gregory-Ksander M, Pasquale LR, Buys ES, Sappington RM. Increased bioavailability of cyclic guanylate monophosphate prevents retinal ganglion cell degeneration. Neurobiol Dis 2018; 121:65-75. [PMID: 30213732 DOI: 10.1016/j.nbd.2018.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/09/2018] [Accepted: 09/03/2018] [Indexed: 02/07/2023] Open
Abstract
The nitric oxide - guanylyl cyclase-1 - cyclic guanylate monophosphate (NO-GC-1-cGMP) pathway has emerged as a potential pathogenic mechanism for glaucoma, a common intraocular pressure (IOP)-related optic neuropathy characterized by the degeneration of retinal ganglion cells (RGCs) and their axons in the optic nerve. NO activates GC-1 to increase cGMP levels, which are lowered by cGMP-specific phosphodiesterase (PDE) activity. This pathway appears to play a role in both the regulation of IOP, where reduced cGMP levels in mice leads to elevated IOP and subsequent RGC degeneration. Here, we investigated whether potentiation of cGMP signaling could protect RGCs from glaucomatous degeneration. We administered the PDE5 inhibitor tadalafil orally (10 mg/kg/day) in murine models of two forms of glaucoma - primary open angle glaucoma (POAG; GC-1-/- mice) and primary angle-closure glaucoma (PACG; Microbead Occlusion Model) - and measured RGC viability at both the soma and axon level. To determine the direct effect of increased cGMP on RGCs in vitro, we treated axotomized whole retina and primary RGC cultures with the cGMP analogue 8-Br-cGMP. Tadalafil treatment increased plasma cGMP levels in both models, but did not alter IOP or mean arterial pressure. Nonetheless, tadalafil treatment prevented degeneration of RGC soma and axons in both disease models. Treatment of whole, axotomized retina and primary RGC cultures with 8-Br-cGMP markedly attenuated both necrotic and apoptotic cell death pathways in RGCs. Our findings suggest that enhancement of the NO-GC-1-cGMP pathway protects the RGC body and axon in murine models of POAG and PACG, and that enhanced signaling through this pathway may serve as a novel glaucoma treatment, acting independently of IOP.
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Affiliation(s)
- Lauren K Wareham
- Anesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital Research Institute, Harvard Medical School, Boston, MA, USA; Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Ana C Dordea
- Anesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital Research Institute, Harvard Medical School, Boston, MA, USA
| | - Grigorij Schleifer
- Anesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital Research Institute, Harvard Medical School, Boston, MA, USA
| | - Vincent Yao
- Anesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital Research Institute, Harvard Medical School, Boston, MA, USA; Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Annabelle Batten
- Anesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital Research Institute, Harvard Medical School, Boston, MA, USA
| | - Fei Fei
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Joseph Mertz
- Department of Ophthalmology, Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Meredith Gregory-Ksander
- Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114, United Sates
| | - Louis R Pasquale
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Emmanuel S Buys
- Anesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital Research Institute, Harvard Medical School, Boston, MA, USA
| | - Rebecca M Sappington
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN 37232, United States; Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN 37232, United States; Department of Ophthalmology and Visual Sciences, Vanderbilt University School of Medicine, Nashville, TN 37232, United States.
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Skrzypecki J, Grabska-Liberek I, Przybek J, Ufnal M. A common humoral background of intraocular and arterial blood pressure dysregulation. Curr Med Res Opin 2018; 34:521-529. [PMID: 29219620 DOI: 10.1080/03007995.2017.1415203] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND It has been postulated that intraocular pressure, an important glaucoma risk factor, correlates positively with arterial blood pressure (blood pressure). However, results of experimental and clinical studies are often contradictory. It is hypothesized that, in some hypertensive patients, disturbances in intraocular pressure regulation may depend on biological effects of blood borne hormones underlying a particular type of hypertension, rather than on blood pressure level itself. REVIEW This review compares the effects of hormones on blood pressure and intraocular pressure, in order to identify a hormonal profile of hypertensive patients with an increased risk of intraocular pressure surge. The PUBMED database was searched to identify pre-clinical and clinical studies investigating the role of angiotensin II, vasopressin, adrenaline, noradrenaline, prostaglandins, and gaseous transmitters in the regulation of blood pressure and intraocular pressure. RESULTS Studies included in the review suggest that intraocular and blood pressures often follow a different pattern of response to the same hormone. For example, vasopressin increases blood pressure, but decreases intraocular pressure. In contrast, high level of nitric oxide decreases blood pressure, but increases intraocular pressure. CONCLUSIONS Arterial hypertension is associated with altered levels of blood borne hormones. Contradicting results of studies on the relationship between arterial hypertension and intraocular pressure might be partially explained by diverse effects of hormones on arterial and intraocular pressures. Further studies are needed to evaluate if hormonal profiling may help to identify glaucoma-prone patients.
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Affiliation(s)
- Janusz Skrzypecki
- a Department of Experimental Physiology and Pathophysiology, Laboratory of Centre for Preclinical Research , Medical University of Warsaw , Warsaw , Poland
- b Department of Ophthalmology , Medical Center for Postgraduate Education , Warsaw , Poland
| | - Iwona Grabska-Liberek
- b Department of Ophthalmology , Medical Center for Postgraduate Education , Warsaw , Poland
| | - Joanna Przybek
- c Department of Experimental and Clinical Pharmacology , Medical University of Warsaw , Poland
| | - Marcin Ufnal
- a Department of Experimental Physiology and Pathophysiology, Laboratory of Centre for Preclinical Research , Medical University of Warsaw , Warsaw , Poland
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Are Erectile Dysfunction Medications Causally Related to Nonarteritic Anterior Ischemic Optic Neuropathy? J Neuroophthalmol 2017; 36:202-7. [PMID: 26828844 DOI: 10.1097/wno.0000000000000342] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Changes in Retinal and Choroidal Vascular Blood Flow after Oral Sildenafil: An Optical Coherence Tomography Angiography Study. J Ophthalmol 2017; 2017:7174540. [PMID: 29129998 PMCID: PMC5654255 DOI: 10.1155/2017/7174540] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 09/16/2017] [Accepted: 09/25/2017] [Indexed: 11/17/2022] Open
Abstract
Purpose To describe changes in the retina and choroidal flow by optical coherence tomography angiography (OCT-A) after a single dose of oral sildenafil. Method A case-control study. Patients in the study group received 50 mg of oral sildenafil. Patients in the control group received a sham pill. Retinal and choroidal images were obtained at baseline (before pill ingestion) and 1 hour after ingestion. Central macular and choroidal thickness, choroidal and outer retina flow, and the retinal and choroidal vascular density were compared using a Mann-Whitney U test. Results Twenty eyes were enrolled into the study group and 10 eyes in the control group. There was a significant difference in central choroidal thickness and outer retina blood flow between groups after 1 hour of sildenafil ingestion (p < 0.01). There were no differences in central macular thickness, choroidal flow, and retinal vascular density among groups. Conclusions A single dose of oral sildenafil increases choroidal thickness, probably due to sildenafil-induced vasodilation.
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Nazari A, Tabrizi YT, Mokhtaree M. Effect of periodic sildenafil dosage on intraocular pressure in patients with erectile dysfunction. Electron Physician 2017; 9:5229-5232. [PMID: 29038701 PMCID: PMC5633217 DOI: 10.19082/5229] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 12/14/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND AND AIM Sildenafil is used to treat erectile dysfunction but it has association with some side effects. This study was conducted with the aim of investigating the effect of duration of taking sildenafil on intraocular pressure (IOP) in patients with erectile dysfunction. METHODS The study population of this cross-sectional study were all males with erectile dysfunction referring to the urology clinic affiliated to Rafsanjan University of Medical Sciences (Kerman, Iran) over a one-year period (2015-2016) among whom 110 patients were included in the study. After medical examinations and required investigations, a weekly dose of 25-100mg sildenafil (50 mg per week on average) was prescribed for patients. IOP in these patients was measured by an ophthalmologist before, one month after and three months after taking medication respectively. Finally, data were analyzed by SPSS version 16 using repeated measures test. RESULTS Mean IOP before taking medication as well as one month and three months after taking sildenafil was 14.88±1.3, 15±1.28 and 15±1.34 mmHg respectively. Analysis of results showed that the difference in IOP in various periods of measurement was significant (p<0.001). Mean IOP before taking sildenafil was significantly different from three months after taking it (p<0.001) and mean IOP one month after taking sildenafil was significantly different from three months after taking it (p=0.002). CONCLUSION Results of this study indicated that taking sildenafil for three months increased IOP. Although these changes may not be clinically significant.
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Affiliation(s)
- Alireza Nazari
- M.D. Urologist, Assistant Professor, Department of Surgery, Physiology-Pharmacology Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Yousof Taghavi Tabrizi
- M.D. Ophthalmologist, Assistant Professor, Department of Ophthalmology and Otorhinolaryngology, Geriatric Care Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Mohammadreza Mokhtaree
- M.Sc. of Educational Psychology, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
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Fuwa K, Hosono S, Nagano N, Takahashi S, Nakashima M. Retinopathy of prematurity after sildenafil treatment. Pediatr Int 2017; 59:360-361. [PMID: 28317302 DOI: 10.1111/ped.13187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 09/16/2016] [Accepted: 10/05/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Kazumasa Fuwa
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Itabashi, Tokyo, Japan
| | - Shigeharu Hosono
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Itabashi, Tokyo, Japan
| | - Nobuhiko Nagano
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Itabashi, Tokyo, Japan
| | - Shori Takahashi
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Itabashi, Tokyo, Japan
| | - Motohiro Nakashima
- Division of Ophthalmology, Department of Visual Sciences, Nihon University School of Medicine, Itabashi, Tokyo, Japan
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Moschos MM, Nitoda E. Pathophysiology of visual disorders induced by phosphodiesterase inhibitors in the treatment of erectile dysfunction. DRUG DESIGN DEVELOPMENT AND THERAPY 2016; 8:3407-3413. [PMID: 27799745 PMCID: PMC5076796 DOI: 10.2147/dddt.s118015] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aim The aim of this review was to summarize the ocular action of the most common phosphodiesterase (PDE) inhibitors used for the treatment of erectile dysfunction and the subsequent visual disorders. Method This is a literature review of several important articles focusing on the pathophysiology of visual disorders induced by PDE inhibitors. Results PDE inhibitors have been associated with ocular side effects, including changes in color vision and light perception, blurred vision, transient alterations in electroretinogram (ERG), conjunctival hyperemia, ocular pain, and photophobia. Sildenafil and tadalafil may induce reversible increase in intraocular pressure and be involved in the development of non-arteritic ischemic optic neuropathy. Reversible idiopathic serous macular detachment, central serous chorioretinopathy, and ERG disturbances have been related to the significant impact of sildenafil and tadalafil on retinal perfusion. Discussion So far, PDE inhibitors do not seem to cause permanent toxic effects on chorioretinal tissue and photoreceptors. However, physicians should write down any visual symptom observed during PDE treatment and refer the patients to ophthalmologists.
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Affiliation(s)
- Marilita M Moschos
- 1st Department of Ophthalmology, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Eirini Nitoda
- 1st Department of Ophthalmology, Medical School, National & Kapodistrian University of Athens, Athens, Greece
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Prasanna G, Li B, Mogi M, Rice DS. Pharmacology of novel intraocular pressure-lowering targets that enhance conventional outflow facility: Pitfalls, promises and what lies ahead? Eur J Pharmacol 2016; 787:47-56. [DOI: 10.1016/j.ejphar.2016.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 02/15/2016] [Accepted: 03/01/2016] [Indexed: 12/18/2022]
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Costa APA, Lima AMV, da Silva LH, de Oliveira Alves Carvalho R, do Amaral AVC, Borges NC. Ocular perfusion pressure and color Doppler imaging of the external ophthalmic artery of rabbits treated with sildenafil citrate. BMC Vet Res 2016; 12:149. [PMID: 27449366 PMCID: PMC4957892 DOI: 10.1186/s12917-016-0778-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 07/19/2016] [Indexed: 11/10/2022] Open
Abstract
Background It has been proposed that sildenafil citrate can increase ocular blood flow, and that this property can be used to treat ocular disorders that involve reflex vasoconstriction. This study therefore proposes to ascertain the vasodilator effect of the drug on retrobulbar circulation in healthy rabbits. For this matter rabbits treated with sildenafil citrate or saline solution had their intraocular pressure (IOP), mean arterial pressure (MAP), ocular perfusion pressure (OPP) and color Doppler imaging of the external ophthalmic artery measured prior to treatment and on days one (moment M1), seven (when M2), fourteen (moment M3), twenty-one (moment M4), and thirty (moment M5) of treatment. Results The MAP and OPP values of treated group were lower than those of control group at all times, and the mean values differed statistically at moments M1 (S = 71.52 mmHg, C = 84.76 mmHg, p = 0.0356) and M5 (S = 71.38 mmHg, C = 85.52 mmHg, p = 0.0252). The IOP and color Doppler values of the external ophthalmic artery did not differ between tested groups. Conclusions The dose of 10 mg of sildenafil citrate administered to healthy rabbits causes systemic vasodilation and consequently lower values of MAP and OPP. However, it does not induce changes in IOP and retrobulbar hemodynamics identifiable by color Doppler assessment of the external ophthalmic artery.
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Affiliation(s)
- Ana Paula Araujo Costa
- Department of Veterinary Medicine, School of Veterinary Medicine and Animal Science, Veterinary Hospital, Federal University of Goiás, Campus Samambaia, Caixa Postal 131, Goiânia, Goiás State, CEP 74001-970, Brazil.
| | - Aline Maria Vasconcelos Lima
- Department of Veterinary Medicine, School of Veterinary Medicine and Animal Science, Veterinary Hospital, Federal University of Goiás, Campus Samambaia, Caixa Postal 131, Goiânia, Goiás State, CEP 74001-970, Brazil
| | - Luiz Henrique da Silva
- Department of Veterinary Medicine, School of Veterinary Medicine and Animal Science, Veterinary Hospital, Federal University of Goiás, Campus Samambaia, Caixa Postal 131, Goiânia, Goiás State, CEP 74001-970, Brazil
| | - Rosângela de Oliveira Alves Carvalho
- Department of Veterinary Medicine, School of Veterinary Medicine and Animal Science, Veterinary Hospital, Federal University of Goiás, Campus Samambaia, Caixa Postal 131, Goiânia, Goiás State, CEP 74001-970, Brazil
| | - Andréia Vitor Couto do Amaral
- Department of Veterinary Medicine, School of Veterinary Medicine and Animal Science, Federal University of Goiás, Jataí, GO, Brazil
| | - Naida Cristina Borges
- Department of Veterinary Medicine, School of Veterinary Medicine and Animal Science, Veterinary Hospital, Federal University of Goiás, Campus Samambaia, Caixa Postal 131, Goiânia, Goiás State, CEP 74001-970, Brazil
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Samiee-Zafarghandy S, van den Anker JN, Laughon MM, Clark RH, Smith PB, Hornik CP. Sildenafil and retinopathy of prematurity risk in very low birth weight infants. J Perinatol 2016; 36:137-40. [PMID: 26491852 PMCID: PMC4731250 DOI: 10.1038/jp.2015.126] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 09/02/2015] [Accepted: 09/08/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To examine the effect of sildenafil therapy on development of severe retinopathy of prematurity (ROP) requiring surgical intervention in premature infants. STUDY DESIGN We identified premature infants who were discharged from Pediatrix Medical Group neonatal intensive care units from 2003 to 2012 and who received an ophthalmologic exam. We matched each infant exposed to sildenafil before first eye exam to three nonexposed infants using propensity scoring to control for differences in baseline infant characteristics. We evaluated the association between sildenafil exposure and development of severe ROP using conditional logistic regression. RESULT Of the 57 815 infants meeting inclusion criteria, 88 were exposed to sildenafil. We matched 81/88 (92%) sildenafil-exposed with 243 nonexposed infants. There was no difference in the proportion of infants who developed severe ROP in the sildenafil-exposed vs nonexposed groups (17/81 (21%) vs 38/243 (16%), P=0.27). On adjusted analysis, there was no difference in severe ROP in the sildenafil-exposed vs nonexposed infants (odds ratio=1.46, 95% confidence interval=0.76 to 2.82, P=0.26). CONCLUSION We did not observe an association between risk of severe ROP and sildenafil exposure before first eye exam in this cohort of premature infants.
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Affiliation(s)
- Samira Samiee-Zafarghandy
- Center for Translational Science, Children’s National Medical Center, Washington, DC, USA
- Division of Clinical Pharmacology, Children’s National Medical Center, Washington, DC, USA
- Department of Pediatrics, McMaster University Medical Center, Hamilton, Ontario, Canada
| | - John N. van den Anker
- Center for Translational Science, Children’s National Medical Center, Washington, DC, USA
- Division of Clinical Pharmacology, Children’s National Medical Center, Washington, DC, USA
- Intensive Care, Erasmus Medical Center-Sophia Children’s Hospital, Rotterdam, the Netherlands
- Department of Paediatric Pharmacology, University Children’s Hospital Basel, Switzerland
| | - Matthew M. Laughon
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Reese H. Clark
- Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL, USA
| | - P. Brian Smith
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Christoph P. Hornik
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
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Bach A, Gold AS, Villegas VM, Wildner AC, Ehlies FJ, Murray TG. Spontaneous exudative retinal detachment in a patient with sturge-weber syndrome after taking arginine, a supplement for erectile dysfunction. EYE AND VISION (LONDON, ENGLAND) 2014; 1:7. [PMID: 26605354 PMCID: PMC4657225 DOI: 10.1186/s40662-014-0007-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 10/09/2014] [Indexed: 11/21/2022]
Abstract
Background Patients with Sturge-Weber syndrome can have ipsilateral diffuse or circumscribed choroidal hemangiomas. These hemangiomas have been seen to undergo spontaneous exudative or hemorrhagic retinal detachments. There is no definitive treatment for these types of retinal detachments, but radiotherapy, photodynamic therapy, oral propranolol, pegaptinib and bevacizumab have been used. Case presentation A 26-year-old male with Sturge-Weber Syndrome developed an exudative retinal detachment that occurred immediately after taking a supplement containing arginine. The patient was treated with intravitreal bevacizumab 1.25 mg in 0.05 ml solution. Resolution of the retinal detachment was seen after 4 treatments over a six-month period. Conclusions Arginine and other medications that cause a release of nitric oxide may lead to intravascular leakage and exudative retinal detachments in patients who have a choroidal hemangioma. Electronic supplementary material The online version of this article (doi:10.1186/s40662-014-0007-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Austin Bach
- Larkin Community Hospital, 7031 SW 62nd Avenue, South Miami, 33143 Florida USA
| | - Aaron S Gold
- Murray Ocular Oncology & Retina, 6705 Red Road, Suite 412, Miami, 33143 Florida USA
| | - Victor M Villegas
- Murray Ocular Oncology & Retina, 6705 Red Road, Suite 412, Miami, 33143 Florida USA
| | - Andrea C Wildner
- Murray Ocular Oncology & Retina, 6705 Red Road, Suite 412, Miami, 33143 Florida USA
| | - Fiona J Ehlies
- Murray Ocular Oncology & Retina, 6705 Red Road, Suite 412, Miami, 33143 Florida USA
| | - Timothy G Murray
- Murray Ocular Oncology & Retina, 6705 Red Road, Suite 412, Miami, 33143 Florida USA
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Alvarez LJ, Zamudio AC, Candia OA. Sildenafil stimulates aqueous humor turnover in rabbits. Exp Eye Res 2013; 111:67-70. [PMID: 23562660 DOI: 10.1016/j.exer.2013.03.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Revised: 03/04/2013] [Accepted: 03/21/2013] [Indexed: 10/27/2022]
Abstract
Sildenafil citrate increases ocular blood flow and accelerates the rate of anterior chamber refilling after paracentesis. The latter effect could have resulted from a reduction in outflow facility or from an increase in aqueous humor (AH) production. In this study, we used scanning ocular fluorophotometry to examine the effects of sildenafil on AH turnover, and thus, AH production in eyes of live normal rabbits. For this, the rate of aqueous humor flow (AHF) was quantified with a commercially available fluorophotometer that measured the rate of fluorescein clearance from the anterior segment, which predominantly occurs via the trabecular meshwork. After ≈2 h of control scans to determine the baseline rate of AHF, the rabbits were fed 33 mg of sildenafil and allowed ≈45 min for the drug to enter the systemic circulation. Thereafter, fluorescence scans were retaken for an additional 90-120 min. Sildenafil ingestion increased AHF by about 36%, from 2.31 μL/min to 3.14 μL/min (P < 0.001, as two-tailed paired data, n = 20 eyes). This observation indicates that sildenafil citrate, which is a phosphodiesterase type-5 inhibitor currently marketed as a vasodilator (e.g., Viagra, Revatio), stimulates AHF in rabbits. Our results seem consistent with reports indicating that the drug dilates intraocular arteries and augments intraocular vascular flow. These physiological responses to the agent apparently led to increased fluid entry into the anterior chamber. As such, the drug might have utility in patients with ocular hypotony resulting from insufficient AH formation.
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Affiliation(s)
- Lawrence J Alvarez
- Department of Ophthalmology, Mount Sinai School of Medicine, Box 1183, Fifth Avenue and 100th Street, New York, NY 10029, USA
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Gerometta R, Alvarez LJ, Candia OA. Sildenafil accelerates anterior chamber refilling after paracentesis in sheep and rabbits. Invest Ophthalmol Vis Sci 2012; 53:565-73. [PMID: 22205610 DOI: 10.1167/iovs.11-8275] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Sildenafil increases ocular blood flow. Thus, the authors investigated if it also increases anterior chamber (AC) refilling after paracentesis. METHODS Corriedale sheep and albino rabbits were used as animal models. Intraocular pressure (IOP) was measured, paracentesis performed on one eye, and AC refilling followed by observation using oblique illumination. IOP measurements continued as the AC formed. After IOP stabilization, sildenafil (100 mg) was orally administered. Forty to 60 minutes later, AH was withdrawn from the contralateral eye. The point at which IOP recovered was used to determine refilling time. Paracentesis volumes were either 60, 120, or 300 μL in sheep, and 50 or 100 μL in rabbits. RESULTS IOP recovered in approximately 49, 56, and 50 minutes after the 60, 120, and 300 μL withdrawals in sheep. The refilling times of the contralateral eye after sildenafil ingestion were approximately 19, 26, and 37 minutes for the respective AH withdrawals. With rabbits, IOP recovered in approximately 13 minutes after the 50 and 100 μL AH withdrawals. After sildenafil, the IOP recovery times of the fellow eye were approximately 6 minutes. AH refilling rates were estimated by dividing the paracentesis volume by IOP recovery time. After sildenafil, such rates were larger than the AH formation rate attributed to secretion by the ciliary epithelium. CONCLUSIONS Sildenafil accelerates the rate of AC refilling and might have beneficial utility as an agent enhancing fluid entry into the AC of patients who experienced AH loss during eye surgery, as well as in some cases of ocular hypotony.
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Affiliation(s)
- Rosana Gerometta
- Departamento de Oftalmología, Universidad Nacional del Nordeste, Corrientes, Argentina
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