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Higher doses of sildenafil citrate can lead to prolonged retinal damage
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At high dosage, sildenafil citrate can lead to persistent retinal toxicity in certain individuals, according to a case report.
A 31-year-old Caucasian man presented with complaints of bilateral multicolored photopsias and erythropsia, shortly after taking sildenafil citrate, which he purchased through the Internet.
He reported not using the measuring pipette provided, had drunk the solution directly from the bottle and was believed to have consumed much more than the 50 mg/mL recommended.
Fundus autofluorescence showed symmetric areas of hyper-autofluorescence slightly temporal to the fovea, bilaterally. The scanning laser ophthalmoscopy near-infrared reflectance images revealed a bullseye pattern with concentric rings of hyporeflectivity and hyperreflectivity, bilaterally.
OCT B-scans demonstrated diffused nodular thickening and irregularities of the central ellipsoid zone associated with thinning and poor delineation of the interdigitation zone.
The patient was treated with topical prednisolone acetate four times a day in both eyes, brinzolamide 1% three times a day in both eyes and brimonidine tartrate twice daily in both eyes. The next day the patient’s symptoms were unchanged.
A trial of prednisone 60 mg once a day for 3 days was initiated, however there was no noticeable improvement, and the steroids were discontinued.
Previous studies of sildenafil citrate at the approved dose for erectile dysfunction have shown that visual side effects are transient, and electroretinogram changes typically resolve within 24 hours, according to researchers.
Findings suggest that sildenafil citrate’s effect on the retina is dose dependent.
“The changes seen in our patient are consistent with photoreceptor toxicity, especially in the macula. The cone cells appear to be more vulnerable,” researchers wrote. – by Abigail Sutton
Disclosures: Yanoga reports no relevant financial disclosures. Please see the full study for remaining authors’ financial disclosures.
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