Retinal and Optic Disc Vascular Changes in Patients Using Long-Term Tadalafil: A Prospective Non-Randomized Matched-Pair Study

Changes in Posterior Ocular Structures in Individuals Using Phosphodiesterase 5 Inhibitor

PURPOSE

To examine posterior ocular structures with optical coherence tomography (OCT) in individuals using a phosphodiesterase 5 inhibitor (PDI, tadalafil).

METHOD

This prospective study included 26 eyes of 26 patients who used 1 tablet of 5-mg tadalafil regularly every day for 1 month due to erectile dysfunction. The routine ophthalmological examinations of the participants were performed at the pre-tadalafil and post-tadalafil first-month visits. At both visits, OCT was used to measure the central retinal thickness (CRT), ganglion cell layer + inner plexiform layer (GCL + IPL) thicknesses, and peripapillary retinal nerve fiber layer (pRNFL; average and superior, temporal, inferior, and nasal quadrants) thicknesses. The disc area, rim area, average and vertical cup/disc ratio, and cup volume of the optic disc head were evaluated. Choroidal thickness was measured from five points: the subfoveal area and the nasal and temporal areas 500 and 1500 microns from the fovea. Choroidal vascular area values and choroidal vascular index (CVI) were calculated using a special binarization technique.

RESULTS

The mean age of the patients was 56 ± 8(range 34-72) years. No significant difference was detected in the CRT,GCL + IPL thicknesses,or pRNFL thicknesses in any of the quadrants before and after tadalafil use. The optic disc head measurements and choroidal thickness values measured from five points were similar between the two visits. The luminal choroidal area was 0.15 ± 0.04 mm2 before tadalafil use and 0.17 ± 0.05 mm2 after 1-month tadalafil use, with no statistically significant difference. The remaining choroidal vascular parameters, namely the stromal and total choroidal area and CVI values, were similar between the two visits.

CONCLUSION

This study showed no significant change in the posterior ocular structures in individuals using tadalafil regular daily use for 1 month due to erectile dysfunction.

Choroidal and retinal alteration after long-term use of tadalafil: a prospective non-randomized clinical trial

OBJECTIVES

The purpose of this study is to investigate choroidal and retinal vascular features in patients taking PDE5is by measuring dynamic vascular alterations and neurostructural features of the retina before and after oral tadalafil administration.

METHODS

The current clinical research involved 22 patients treated with tadalafil 20 mg on alternate days (OAD) after nerve-sparing robotic radical prostatectomy (NS-RARP) for prostate cancer. Patients underwent SD-OCT to assess ganglion cell complex (GCC), retinal nerve fiber layer (RNFL), and subfoveal choroidal thickness (SFCT), as well as OCTA to assess superficial capillary plexus (SCP), deep capillary plexus (DCP), choriocapillaris (CC), foveal avascular zone (FAZ), and radial peripapillary capillary thickness (RPC). All patients were evaluated at baseline (t0), and 3 (t1) and 6 (t2) months after the use of oral tadalafil.

RESULTS

A statistically significant reduction in DCP and CC vessel density was found at t2 compared to baseline. According to the SFCT parameter, a statistically significant increase was observed from t0 to t1, and from t1 to t2. GCC parameter increased at t2 compared to baseline in a statistically significant way. No statistically significant differences were recorded between t0, t1 and t2 for the SCP, RPC, FAZ area, RNFL parameter.

CONCLUSIONS

Retinal and optic disc toxicity may be detected using modifications of capillary vessel density. Further studies are needed to detect the possible progression or regression of ocular or systemic vascular complications in long-term follow-up.

Icarifil® in Association with Daily Use of Tadalafil (5 mg) versus Standard Tadalafil Daily Dose (5 mg) or Alone: Results from a Controlled, Randomized Clinical Trial

Background: The management of erectile dysfunction (ED) shows several grey zones and new treatments are required to reduce the percentage of patients discontinuing treatment. Here, we aim to evaluate the role of a natural mixture named Icarifil® (L-Citrulline, L-Carnitine, Eruca vesicaria, Panax ginseng, Tribulus terrestris, Turnera diffusa, Taurine, Vitamin E, Zinc) in the management of patients with ED. Methods: From September 2022 to March 2023, all patients attending 3 urological institutions due to ED were randomized to receive the following for 3 months: Icarifil® 1 sachet every 24 h (Group 1) or Icarifil® 1 sachet + tadalafil 5 mg 1 tablet every 24 h (Group 2) or tadalafil 5 mg 1 tablet daily (Group 3). All patients underwent urologic visits and dedicated questionnaires (IIEF-5, SEP-2, SEP-3) at enrollment and at the follow-up evaluation (3 months). Patient-Reported Outcomes (PROs) at the follow-up evaluation were used. The primary endpoint was the difference in the questionnaires at the follow-up visit compared to the one at enrollment among the study groups. Results: In the per-protocol analysis, 52 patients in Group 1, 55 in Group 2 and 57 in Group 3 were analyzed. At the follow-up evaluation, IIEF-5 scores improved in all the 3 groups between enrollment and the follow-up evaluation, but a statistically significant difference was reported between Group 2 (+7.4) and Group 1 (+4.1) or Group 3 (+5.1), (p < 0.001; p < 0.001). Moreover, 47 patients (94.0%) in Group 2 showed an improvement in the SEP questionnaires, when compared with the baseline, while 29 in Group 1 (56.9%) and 42 in Group 3 (82.3%) showed a statistically significant difference (p = 0.004; p = 0.003) among the groups. The PRO analysis reported better efficacy and patient satisfaction in Group 2 when compared with Group 1 or Group 3. Conclusions: In conclusion, Icarifil® is able to improve penile erectile function in mild-moderate ED and significantly improve the clinical efficacy of daily used tadalafil 5 mg. Icarifil® could represent an interesting alternative treatment in patients experiencing adverse effects or with contraindications for chronic treatment with PDE5-is.

The relationship between the history of PDE5-inhibitors assumption and melanoma: a systematic review

INTRODUCTION

Phosphodiesterase 5 inhibitors (PDE5-is) are used worldwide as first line therapy for erectile dysfunction (ED). Current literature reported data on the warning association between PDE5-is use and the development of cutaneous melanoma. However, these data are contrasting, thus we aim to summarise evidence regarding this association.

CONTENT

A systematic review of all published articles related to the effects of PDE5-is in the development of cutaneous melanoma was performed. PubMed, EMBASE, and Cochrane library were queried for all the published studies indexed up to the 26th of May 2023. A combination of keywords related to PDE5-is and melanoma were used. Only original studies based on human subjects in the English language were included in the analysis.

SUMMARY AND OUTLOOK

Of 505 articles identified, only eight original articles were considered for further analysis. Overall, five of the selected articles including 657,984 subjects agrees on an increased risk of developing melanoma in PDE5-is users. On the other hand, three original articles based on data regarding 360,915 subjects, disagree with the previous statement declaring any association between PDE5-i use and melanoma. Current literature still reports contrasting data regarding the association between PDE5-is assumption and increased risk of melanoma, but a possible association is described, bringing attention to higher risk melanoma category of patients. More clinical studies are needed to clarify the impact of PDE5-is in the development and progression of melanoma.

Central retinal vein and artery occlusion associated with sildenafil: a case report and review of the literature

BACKGROUND

Sildenafil is a selective phosphodiesterase type 5 inhibitor used for the treatment of erectile dysfunction and pulmonary hypertension. It is available over the counter in many countries. While there have been a few reports of retinal vascular occlusion following sildenafil consumption, most cases have other comorbidities as risk factors for the disease, and the exact causal role of this drug in these conditions remains unclear.

CASE PRESENTATION

We present the case of a healthy 32-year-old Iranian man who developed combined central retinal vein occlusion and retinal artery occlusion following sildenafil exposure. The patient underwent a hypercoagulative state workup for possible underlying risk factors. Additionally, we conducted a literature search on PubMed using the keywords: retinal vein occlusion AND Sildenafil OR Viagra, retinal artery occlusion AND Sildenafil OR Viagra, retinal vascular occlusion AND Sildenafil OR Viagra. To obtain more objective results in the reviews, we employed an adverse drug reaction possibility algorithm. The patient was found to be otherwise healthy, and ancillary tests were unremarkable. A literature review identified seven reports of retinal vascular occlusion following sildenafil use. In most of these cases, the role of sildenafil was not clearly established. To the best of our knowledge, our case achieved the highest score based on the algorithm compared with previous reports.

CONCLUSION

Sildenafil may be associated with severe retinal vascular accidents in otherwise healthy young individuals.

Decision Trees for Glaucoma Screening Based on the Asymmetry of the Retinal Nerve Fiber Layer in Optical Coherence Tomography

Purpose: The aim of this study was to analyze the relevance of asymmetry features between both eyes of the same patient for glaucoma screening using optical coherence tomography. Methods: Spectral-domain optical coherence tomography was used to estimate the thickness of the peripapillary retinal nerve fiber layer in both eyes of the patients in the study. These measurements were collected in a dataset from healthy and glaucoma patients. Several metrics for asymmetry in the retinal nerve fiber layer thickness between the two eyes were then proposed. These metrics were evaluated using the dataset by performing a statistical analysis to assess their significance as relevant features in the diagnosis of glaucoma. Finally, the usefulness of these asymmetry features was demonstrated by designing supervised machine learning models that can be used for the early diagnosis of glaucoma. Results: Machine learning models were designed and optimized, specifically decision trees, based on the values of proposed asymmetry metrics. The use of these models on the dataset provided good classification of the patients (accuracy 88%, sensitivity 70%, specificity 93% and precision 75%). Conclusions: The obtained machine learning models based on retinal nerve fiber layer asymmetry are simple but effective methods which offer a good trade-off in classification of patients and simplicity. The fast binary classification relies on a few asymmetry values of the retinal nerve fiber layer thickness, allowing their use in the daily clinical practice for glaucoma screening.

Applications of Optical Coherence Tomography in the Ocular Diagnosis: From the Tear Film to the Sclera

The latest technological developments have radically impacted the daily practice of ophthalmologists, thanks to the advent of novel diagnostic tools that facilitate an early diagnosis and allow a better management of ocular disorders [...]