RESUMO
We report a case of anterior ischemic optic neuropathy associated with udenafil. A 54-year-old male presented with an acute onset visual field defect of the right eye after udenafil use. Examination revealed a relative afferent pupillary defect and a swollen disc. Automated visual fields revealed an enlarged blind spot and a narrowed visual field. Fluorescein angiography revealed both an inferior choroidal filling delay and an inferior sector filling delay of the optic disc in the arteriovenous phase as well as diffuse leakage of the optic disc in the late phase. Optical coherent tomography revealed increased thickness of the retinal nerve fiber layer, especially in the area of the inferior disc. The patient was counseled to discontinue the use of udenafil and to monitor his blood pressure regularly. The disc swelling was resolved with residual optic atrophy one month after discontinuing the use of udenafil.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Doença Aguda , Corioide/patologia , Neuropatia Óptica Isquêmica/induzido quimicamente , Inibidores da Fosfodiesterase 5/efeitos adversos , Pirimidinas/efeitos adversos , Sulfonamidas/efeitos adversos , Tomografia de Coerência Óptica , Campos VisuaisRESUMO
The purpose of this study was to evaluate the neuroprotective effect of memantine, a N-methyl-D-aspartate antagonist, in an experimental optic nerve ischemia. Endothelin-1 (ET-1) in a dosage of 0.1 microg/day was delivered to the perineural region of the anterior optic nerve by osmotically driven minipumps for 8 weeks in 10 rabbits. In 5 rabbits, 1 mg/kg memantine was administered concurrently by intramuscular injection once a daily. Morphologic optic nerve head changes were monitored with a confocal scanning laser ophthalmoscope. Multivariate statistical analysis showed a significant change in topometric parameters (cup area, cup depth and rim volume), indicating an increase in optic nerve head cupping and a decrease of neural rim volume in the ET-1 administered eyes (P < 0.0001). In rabbits where memantine was given concurrently with ET-1, no significant change in topometric parameters was observed after ET-1 administration (P = 0.78). The current results suggest that memantine has a neuroprotective effect in optic nerve ischemia. Memantine may potentially be useful in the management of various ischemic disorders of the optic nerve, including glaucoma.