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Maculopathy associated with tacrolimus (FK 506).

Koh T, Baek SH, Han JI, Kim US - Korean J Ophthalmol (2011)

Bottom Line: Although the foveal reflex was slightly decreased, fluorescein angiography revealed non-specific signs, with the exception of a window defect.A multifocal electro-retinogram revealed decreased amplitude of the central ring.These findings suggest that tacrolimus may result in maculopathy.

View Article: PubMed Central - PubMed

Affiliation: Myung-Gok Eye Research Institute, Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea.

ABSTRACT
A 63-year-old man with a history of liver transplantation presented to our clinic complaining of visual disturbance. He had been receiving tacrolimus (FK 506) for 30 months (6 mg/day for 2 years and 3 mg/day for 6 months); he reported that the visual disturbance began while taking tacrolimus. A full ophthalmologic examination and electrophysiologic and imaging studies were performed. The best corrected visual acuity was 0.1 in both eyes. There were no abnormal finding in the anterior segment, pupillary reflexes were normal and, there was no swelling in either optic disc. Although the foveal reflex was slightly decreased, fluorescein angiography revealed non-specific signs, with the exception of a window defect. A multifocal electro-retinogram revealed decreased amplitude of the central ring. A Swedish interactive threshold algorithm-standard 10-2 visual field test revealed a central scotoma. These findings suggest that tacrolimus may result in maculopathy. Therefore, careful ophthalmologic examination is necessary in the patients taking tacrolimus.

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Related in: MedlinePlus

The multifocal electroretinogram demonstrated foveal suppression in both eyes (A,B). A central scotoma was noted on central 10-2 threshold visual field testing (C,D). MD=mean deviation; PSD=pattern standard deviation.
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Figure 3: The multifocal electroretinogram demonstrated foveal suppression in both eyes (A,B). A central scotoma was noted on central 10-2 threshold visual field testing (C,D). MD=mean deviation; PSD=pattern standard deviation.

Mentions: His best corrected visual acuity was 20/200 in both eyes. Both pupils were reactive to light, and no relative afferent pupillary defect was noted. The intraocular pressure was 9 mmHg in the right eye and 10 mmHg in the left eye. Both lenses were mildly opacified on slit lamp examination. The Ishihara color test showed total dyschromatopsia in both eyes. No swelling or pallor was noted in either optic disc. Although the foveal reflex was slightly decreased, no bulls eye phenomenon was noted. Fluorescein angiography revealed non-specific signs, with only a window defect caused by retinal pigment epithelium (RPE) atrophy (Fig. 1). Optical coherence tomography also revealed non-specific finding in the fovea (Fig. 2). Electroretinography (ERG) demonstrated a delayed a wave and b wave latency during the photopic response; the response amplitude was slightly decreased in the left eye. Multifocal ERG showed decreased amplitude in the central ring one in both eyes (Fig. 3A and 3B). The Humphrey perimeter (Humphrey Instruments Inc., San Leandro, CA, USA) static visual field with central 10-2 threshold test revealed a central scotoma (Fig. 3C and 3D). Visual evoked potential (VEP) testing demonstrated a P100 delay in both eyes (Fig. 4). A coagulation factor deficiency was not found and the platelet count was within the normal range on serologic testing. Computed tomography revealed no abnormalities. At the final visit, the patient's best corrected visual acuity was maintained at 20/200 in both eyes, some RPE changes were observed on fundus examination.


Maculopathy associated with tacrolimus (FK 506).

Koh T, Baek SH, Han JI, Kim US - Korean J Ophthalmol (2011)

The multifocal electroretinogram demonstrated foveal suppression in both eyes (A,B). A central scotoma was noted on central 10-2 threshold visual field testing (C,D). MD=mean deviation; PSD=pattern standard deviation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3039201&req=5

Figure 3: The multifocal electroretinogram demonstrated foveal suppression in both eyes (A,B). A central scotoma was noted on central 10-2 threshold visual field testing (C,D). MD=mean deviation; PSD=pattern standard deviation.
Mentions: His best corrected visual acuity was 20/200 in both eyes. Both pupils were reactive to light, and no relative afferent pupillary defect was noted. The intraocular pressure was 9 mmHg in the right eye and 10 mmHg in the left eye. Both lenses were mildly opacified on slit lamp examination. The Ishihara color test showed total dyschromatopsia in both eyes. No swelling or pallor was noted in either optic disc. Although the foveal reflex was slightly decreased, no bulls eye phenomenon was noted. Fluorescein angiography revealed non-specific signs, with only a window defect caused by retinal pigment epithelium (RPE) atrophy (Fig. 1). Optical coherence tomography also revealed non-specific finding in the fovea (Fig. 2). Electroretinography (ERG) demonstrated a delayed a wave and b wave latency during the photopic response; the response amplitude was slightly decreased in the left eye. Multifocal ERG showed decreased amplitude in the central ring one in both eyes (Fig. 3A and 3B). The Humphrey perimeter (Humphrey Instruments Inc., San Leandro, CA, USA) static visual field with central 10-2 threshold test revealed a central scotoma (Fig. 3C and 3D). Visual evoked potential (VEP) testing demonstrated a P100 delay in both eyes (Fig. 4). A coagulation factor deficiency was not found and the platelet count was within the normal range on serologic testing. Computed tomography revealed no abnormalities. At the final visit, the patient's best corrected visual acuity was maintained at 20/200 in both eyes, some RPE changes were observed on fundus examination.

Bottom Line: Although the foveal reflex was slightly decreased, fluorescein angiography revealed non-specific signs, with the exception of a window defect.A multifocal electro-retinogram revealed decreased amplitude of the central ring.These findings suggest that tacrolimus may result in maculopathy.

View Article: PubMed Central - PubMed

Affiliation: Myung-Gok Eye Research Institute, Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea.

ABSTRACT
A 63-year-old man with a history of liver transplantation presented to our clinic complaining of visual disturbance. He had been receiving tacrolimus (FK 506) for 30 months (6 mg/day for 2 years and 3 mg/day for 6 months); he reported that the visual disturbance began while taking tacrolimus. A full ophthalmologic examination and electrophysiologic and imaging studies were performed. The best corrected visual acuity was 0.1 in both eyes. There were no abnormal finding in the anterior segment, pupillary reflexes were normal and, there was no swelling in either optic disc. Although the foveal reflex was slightly decreased, fluorescein angiography revealed non-specific signs, with the exception of a window defect. A multifocal electro-retinogram revealed decreased amplitude of the central ring. A Swedish interactive threshold algorithm-standard 10-2 visual field test revealed a central scotoma. These findings suggest that tacrolimus may result in maculopathy. Therefore, careful ophthalmologic examination is necessary in the patients taking tacrolimus.

Show MeSH
Related in: MedlinePlus