Optic atrophy after sildenafil use

Phosphodiesterase Type 5 Inhibitors and Visual Side Effects: A Narrative Review

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.

[Acute monocular loss of vision : Differential diagnostic considerations apart from the internistic etiological clarification]

We report the case of acute painless monocular loss of vision in a 53-year-old man. An interdisciplinary etiological evaluation remained without pathological findings with respect to arterial branch occlusion. A reevaluation of the patient history led to a possible association with the administration of phosphodiesterase type 5 inhibitor (PDE5 inhibitor). A critical review of the literature on PDE5 inhibitor administration with ocular participation was performed.

Improving erectile function of spontaneously hypertensive rats by silencing ROCK2

OBJECTIVE

To improve the erectile function of spontaneously hypertensive rats (SHRs) by silencing Rho-associated protein kinase 2 (ROCK2).

METHODS

Wistar-Kyoto rats (WKYs) and SHRs injected with 20-μL saline (WKY saline control and SHR saline control; n = 10) or 20 μL of 3 × 10(6) transducing units per milliliter negative control lentivirus (WKY negative control and SHR negative control; n = 10) were set as controls. After selecting the best inhibitory small interference ribonucleic acid (siRNA) by transducing 4 kinds of the lentiviral vector-based siRNA-targeting ROCK2 messenger ribonucleic acid (mRNA) respectively into cultured cavernous smooth muscle cells, 20 μL of 3 × 10(6) transducing units per milliliter of the lentiviral vectors were prepared and injected into the corpora cavernosa of WKYs (WKY siRNA; n = 10) and SHRs (SHR siRNA; n = 10). Seven days later, the maximum intracavernosal pressure to mean arterial pressure ratio (ICPmax/MAP), the expression levels of ROCK2, endothelial nitric oxide synthase (eNOS), and phosphorylated eNOS in the penis were measured and determined.

RESULTS

In cavernous smooth muscle cells of SHR culture, 3 kinds of ROCK2 siRNA significantly inhibited ROCK2 mRNA expression. The lentiviral vector-based siRNA-targeting ROCK2 mRNA at the 2287th nucleotide position significantly increased the ICPmax/MAP in the SHR siRNA group more than in SHR saline control and SHR negative control groups. There was no significant difference in the ICPmax/MAP among WKY saline control, WKY negative control and WKY siRNA groups. The ICPmax/MAP in the SHR siRNA group was significantly lower than that in the WKY saline control group. ROCK2 expression in the penis was significantly decreased in SHR siRNA group compared with that in SHR saline control and SHR negative control groups. The expression of eNOS and phosphorylated eNOS was significantly increased in SHR siRNA compared with that in SHR saline control and SHR negative control groups.

CONCLUSION

The gene therapy with lentiviral vector-based siRNA-targeting ROCK2 mRNA can significantly improve erectile function mainly by directly inhibiting ROCK2 pathway in the SHR.

Iatrogenic neurology

Iatrogenic disease is one of the most frequent causes of hospital admissions and constitutes a growing public health problem. The most common type of iatrogenic neurologic disease is pharmacologic, and the central and peripheral nervous systems are particularly vulnerable. Despite this, iatrogenic disease is generally overlooked as a differential diagnosis among neurologic patients. The clinical picture of pharmacologically mediated iatrogenic neurologic disease can range from mild to fatal. Common and uncommon forms of drug toxicity are comprehensively addressed in this chapter. While the majority of neurologic adverse effects are listed and referenced in the tables, the most relevant issues are further discussed in the text.