Monotherapy with mirabegron had a better tolerance than the anticholinergic agents on overactive bladder: A systematic review and meta-analysis.

BACKGROUND: We conducted this meta-analysis to explore the tolerance of monotherapy with mirabegron (50 mg) on an overactive bladder, compared with a common dosage of anticholinergic agents. MATERIALS AND METHODS: A comprehensive search for all randomized controlled trials that evaluated the safety of mirabegron and anticholinergic agents on overactive bladder was performed, and we searched the Cochrane Central Register of Controlled trials databases, Pubmed, Embase, and relevant trials from 2013.02 to 2019.10. RESULTS: Eight studies included 5500 patients with treatment of monotherapy on overactive bladder were identified. The total number of treatment-emergent adverse events had no significantly difference between two monotherapies (RR = 0.88 95%CI: 0.76-1.01; P = .08); however, patients would have a better tolerance with mirabegron (50 mg) in adverse events of dry mouth (RR = 0.42; 95%CI: 0.33-0.53; P < .01) and tachycardia (RR = 0.52; 95%CI: 0.29-0.94; P = .03); and there were no significant differences between two groups in hypertension (RR = 1.02; 95%CI: 0.80-1.30; P = .90), constipation (RR = 0.91; 95%CI: 0.65-1.26; P = 0.57), blurred vision (RR = 1.03; 95%CI: 0.60-1.77; P = 0.92), and urinary tract infection (RR = 0.90; 95%CI: 0.70-1.16; P = .41). CONCLUSIONS: Treatment-emergent adverse events in patients with overactive bladder who underwent monotherapy of mirabegron (50 mg) or the anticholinergic agents had no significant differences, but mirabegron has a better tolerance in the aspect of dry mouth and tachycardia.

Low-dose oral hydroxychloroquine led to impaired vision in a child with renal failure: Case report and literature review.

INTRODUCTION: Hydroxychloroquine (HCQ) has received much attention in the treatment of coronavirus disease 2019 recently. However, it can cause irreversible vision loss. Few cases have been reported in pediatric patient with HCQ-related adverse reactions. Appropriate administration and early disease recognition are important for reducing the adverse drug reactions of HCQ. PATIENT CONCERNS: We report a case of a 14-year-old Chinese girl who sought treatment for rapidly decreasing vision in the left eye over 3 days. The simulation results of the population pharmacokinetic model of HCQ revealed that the plasma concentration of HCQ abnormally increased before the visual acuity of the eye decreased. DIAGNOSIS: She was diagnosed as HCQ related drug adverse reaction. INTERVENTIONS: The daily dose of HCQ for this patient was adjusted from 100 mg/d to 50 mg/d. OUTCOMES: Follow-up for 6 months showed no more vision loss recurrence. However, the existing decreased visual acuity of the eye did not recover either. CONCLUSION: Although decreased visual acuity is an infrequent symptom, ophthalmologists should be aware of the possibility of HCQ concentration enrichment and consider minimizing HCQ use when a child with renal hypofunction seeks treatment for shortsightedness.

Antipsychotic pitfalls: idiopathic intracranial hypertension and antipsychotic-induced weight gain.

Idiopathic intracranial hypertension (IIH) is a condition associated with poor vision and headaches that can cause disability and reduced quality of life. The onset of IIH is typically associated with sudden weight gain and obesity, which may be due to first-generation or second-generation antipsychotics. This case involved the use of quetiapine in an obese, 28-year-old woman; she gained significant weight after starting the antipsychotic and later developed headaches and blurred vision. Reducing quetiapine and administering acetazolamide significantly improved her symptoms within 4 weeks. This case reminds physicians to consider IIH as a cause of headache and vision loss in patients who have gained weight after starting or increasing quetiapine.

Anisocoria secondary to inadvertent contact with scopolamine patch.

A unilaterally fixed mydriasis, also known as a 'blown pupil,' is considered an ominous sign concerning for intracranial pathology. Causes of anisocoria can range from benign to immediately life-threatening. When a patient presents with anisocoria, the concern for a fatal diagnosis leads the clinician to obtain numerous tests, many of which may be unnecessary. The authors present a case of a healthy woman in her 30s who presented with an acute unilateral mydriasis likely secondary to inadvertent contact with a scopolamine patch. On examination, she had no other neurological deficits. Further investigation did not reveal any abnormality. In the event of a patient with an isolated mydriasis in an otherwise healthy and conversant patient with no other neurological deficits, it is essential to rule out other causes before pursuing aggressive and unnecessary testing and treatment.

RISK FOR LOW VISUAL ACUITY AFTER 1 AND 2 YEARS OF TREATMENT WITH RANIBIZUMAB OR BEVACIZUMAB FOR PATIENTS WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION.

PURPOSE: To investigate how patients with neovascular age-related macular degeneration treated with ranibizumab or bevacizumab respond to treatment in daily clinical practice. METHODS: Data from the Swedish Macula Register on the treatment received by 3,912 patients during 2011 to 2014 is reported. Patients' characteristics at the first visit, visual acuity, number of injections, and reason for terminating the treatment if applicable are discussed. Furthermore, the risk of having poor vision (visual acuity under 60 Early Treatment Diabetes Retinopathy Study letters or approximately 20/60 Snellen) is calculated for the treated eye after 1 year and 2 years. RESULTS: The treatment outcome depends on the visual acuity at the first visit. For patients with visual acuity more than 60 letters, the risk of having a visual acuity lower than 60 letters after 1 year or 2 years of treatment is approximately 20%. However, for patients with low visual acuity at diagnosis (fewer than 60 letters), the risk is approximately 60%. The risk of having a visual acuity lower than 60 letters does not depend on the choice of treatment drug. CONCLUSION: Treatment with anti-vascular endothelial growth factor intravitreal injections mainly maintains the visual acuity level, and only approximately 20% and 40% of the patients required vision rehabilitation after 1 year and 2 years, respectively.

VISION LOSS IN A PATIENT WITH PRIMARY PULMONARY HYPERTENSION AND LONG-TERM USE OF SILDENAFIL.

PURPOSE: To describe a case of bilateral, asymmetrical outer macular atrophy in a patient with pulmonary hypertension treated with long-term sildenafil (Revatio). METHODS: Case report with fundus photography, spectral domain optical coherence tomography, fundus autofluorescence, and fluorescein angiography imaging. RESULTS: A 32-year-old African American woman with a history of primary pulmonary hypertension and 5-year history of oral sildenafil (Revatio) use presented with decreasing central vision in her left eye. She reported a decline in central vision in the left eye that started 1 month after treatment initiation and progressed until discontinuation 5 years later. Visual acuity was 20/20 in the right eye and 20/100 in the left eye. Fundus photography revealed retinal pigment epithelial mottling and atrophy in the right eye and parafoveal retinal pigment epithelial mottling and atrophy in a ring-like configuration of the left eye. Optical coherence tomography demonstrated outer retinal irregularity in the right eye and disrupted outer retina involving the external limiting membrane, inner segment/outer segment junction, and the retinal pigment epithelium in the left eye; no choroidal thickening was observed. Fundus autofluorescence showed mild hypoautofluorescence in the foveal center with an irregular autofluorescence pattern in the parafovea of the left eye. Fluorescein angiography revealed capillary dropout with pinpoint hyperfluorescence and leakage in the far periphery bilaterally. A window defect was also observed in the foveal center of the left eye. CONCLUSION: Sildenafil and other PDE5 inhibitors have been associated with several ocular side effects. However, this is the first report in the literature of outer macular atrophy in a patient with pulmonary hypertension and long-term use of oral sildenafil. All patients with long-term use of sildenafil should be educated on the risk of potential visual adverse effects.

IATROGENIC OCCLUSION OF THE OPHTHALMIC ARTERY AFTER SODIUM TETRADECYL SULFATE INJECTION IN THE FOREHEAD.

PURPOSE: To describe a patient with ophthalmic artery occlusion after sodium tetradecyl sulfate foam injection in the forehead. METHODS: In this case report, a description of the clinical examination and imaging findings, including fundus photography, spectral-domain optical coherence tomography, and fluorescein angiography are reported. RESULTS: A 33-year-old white woman presented with severe painless vision loss in the left eye after cosmetic treatment of a forehead vein with sodium tetradecyl sulfate foam. Her visual acuity in the left eye was hand motions, and her fundus revealed diffuse retinal whitening in the macula with the absence of a cherry red spot and disruption of the arteriolar blood supply. Spectral-domain optical coherence tomography revealed intense hyperreflectivity of the inner and outer retina with loss of the foveal contour, and fluorescein angiography revealed delayed filling of the choroidal vasculature and cilioretinal artery with incomplete filling of the retinal arterioles in the late frames consistent with ophthalmic artery occlusion. CONCLUSION: This case represents a devastating ocular complication after the inadvertent injection of sodium tetradecyl sulfate into a forehead artery, resulting in occlusion of the ophthalmic artery and severe vision loss.

Bilateral central serous retinopathy in a patient with paroxysmal nocturnal hemoglobinuria treated with deferoxamine.

PURPOSE: To report a case of acute bilateral central serous retinopathy associated with deferoxamine therapy in the context of paroxysmal nocturnal hemoglobinuria. METHODS: Spectral-domain optical coherence tomography and fundus autofluorescence were used to investigate posterior segment changes. RESULTS: A 76-year-old man with paroxysmal nocturnal hemoglobinuria and hereditary spherocytosis was started on deferoxamine for iron overload secondary to previous blood transfusions. Four days after initiation of treatment, he developed bilateral reduced vision and metamorphopsia. He was noted to have bilateral central serous retinopathy. Symptoms and serous retinal detachment resolved rapidly following discontinuation of treatment. CONCLUSIONS: This case represents the first report of acute bilateral central serous retinopathy associated with deferoxamine therapy. Cessation of deferoxamine resulted in rapid visual recovery.

Ethambutol/Linezolid Toxic Optic Neuropathy.

PURPOSE: To report a rare toxic optic neuropathy after long-term use of two medications: ethambutol and linezolid. CASE REPORT: A 65-year-old man presented to the Miami Veterans Affairs Medical Center in December 2014 for evaluation of progressive vision decrease in both eyes. The patient presented with best-corrected visual acuities of 20/400 in the right eye and counting fingers at 5 feet in the left eye. Color vision was significantly reduced in both eyes. Visual fields revealed a cecocentral defect in both eyes. His fundus and optic nerve examination was unremarkable. Because vision continued to decline after discontinuation of ethambutol, linezolid was also discontinued, after which vision, color vision, and visual fields improved. Because of these findings, the final diagnosis was toxic optic neuropathy. Final visual outcome was 20/30 in the right eye and 20/40 in the left eye. CONCLUSIONS: Drug-associated toxic optic neuropathy is a rare but vision-threatening condition. Diagnosis is made based on an extensive case history and careful clinical examination. The examination findings include varying decrease in vision, normal pupils and extraocular muscles, and unremarkable fundoscopy, with the possibility of swollen optic discs in the acute stage of the optic neuropathy. Other important findings descriptive of toxic optic neuropathy include decreased color vision and cecocentral visual field defects. This case illustrates the importance of knowledge of all medications and/or substances a patient consumes that may cause a toxic reaction and discontinuing them immediately if the visual functions are worsening or not improving.

Steroid-induced glaucoma and childhood blindness.

AIM: To determine the prevalence, risk factors and the severity of visual loss caused by steroid-induced glaucoma (SIG) among children. METHODS: Five-year records of all paediatric glaucoma cases presenting to the glaucoma services of our tertiary care centre were evaluated. Data of children presenting with SIG were recorded with respect to their visual acuity, highest baseline intraocular pressure, cup:disc ratio, perimetry and need of glaucoma filtering surgery. Parents were interviewed to assess the indication of steroid use, type of steroid used, person prescribing it and the duration of use. The prevalence of visual impairment was calculated based on WHO criteria. RESULTS: Of 1259 cases of paediatric glaucoma presenting at our centre over 5 years, 59 children (4.7%) were diagnosed with SIG. Of these, 51 (87%) had been prescribed topical steroids for vernal keratoconjunctivitis (VKC). The median duration of steroid use was 18 months (range 1 month to 8 years). Also, 82% of children with VKC had been prescribed steroids by the treating ophthalmologist and 52% had been on topical steroids for >1 year. Glaucomatous optic neuropathy was the cause of blindness in 37.3% (22/59) and low vision in 23.7% (14/59) children. And 27% (16/59) were unilaterally blind at presentation. CONCLUSIONS: A third of the children presenting with SIG to our tertiary care centre were bilaterally blind at presentation. Ophthalmologists need to consider steroid-sparing agents to treat VKC and monitor these children closely for glaucoma if they prescribe topical steroids in order to prevent unnecessary childhood blindness.

Spectral domain optical coherence tomography findings in long-term silicone oil-related visual loss.

PURPOSE: To investigate spectral domain optical coherence tomography findings in long-term silicone oil-related visual loss. METHODS: Four symptomatic patients were reviewed 4 years to 9 years after vitrectomy with silicone oil tamponade for macula-on retinal detachment. Three lost vision with oil in situ, with one at the time of oil removal. Eleven control eyes with good vision were included. Patients underwent assessment of best-corrected visual acuity, contrast sensitivity, Farnsworth-Munsell 100 Hue testing, static perimetry, and spectral domain optical coherence tomography imaging of the macula and disk. RESULTS: Long-term best-corrected visual acuity was significantly reduced in affected eyes (range, 0.44-1.02), as was contrast sensitivity (0.75-1.35) and color discrimination (Farnsworth-Munsell-100 Hue score, 151-390). Static perimetry showed a central scotoma in all affected eyes. Optical coherence tomography revealed microcystic macular changes in the inner nuclear layer of all affected eyes associated with severe loss of the papillofoveal retinal nerve fiber layer. In one patient, serial optical coherence tomography images showed development of microcystic macular changes 18 months after oil removal. Control eyes lacked these features, except two asymptomatic eyes that showed microcystic changes on optical coherence tomography with a corresponding paracentral scotoma. CONCLUSION: We have demonstrated microcystic macular changes in the inner nuclear layer of affected eyes, as well as focal severe loss of the papillofoveal projection. These changes share significant morphologic features reported in multiple sclerosis-associated optic neuritis and Leber hereditary optic neuropathy.

Oestrogen, ocular function and low-level vision: a review.

Over the past 10 years, a literature has emerged concerning the sex steroid hormone oestrogen and its role in human vision. Herein, we review evidence that oestrogen (oestradiol) levels may significantly affect ocular function and low-level vision, particularly in older females. In doing so, we have examined a number of vision-related disorders including dry eye, cataract, increased intraocular pressure, glaucoma, age-related macular degeneration and Leber's hereditary optic neuropathy. In each case, we have found oestrogen, or lack thereof, to have a role. We have also included discussion of how oestrogen-related pharmacological treatments for menopause and breast cancer can impact the pathology of the eye and a number of psychophysical aspects of vision. Finally, we have reviewed oestrogen's pharmacology and suggest potential mechanisms underlying its beneficial effects, with particular emphasis on anti-apoptotic and vascular effects.

Chronic angle-closure glaucoma related to paroxetine treatment.

PURPOSE: To present a unique case of a 33-year-old woman using paroxetine who presented with acute unilateral visual loss due to chronic angle-closure glaucoma. METHODS: Case report. RESULTS: A 33-year-old women who had been under paroxetine treatment for the past four months presented at the emergency room due to a sudden loss of visual acuity (VA) in the left eye (LE). Narrow anterior chamber was detected. Intraocular pressure (IOP) was 29 mmHg right eye (RE) and 42 mm Hg LE. A fundus exam revealed a cup-to-disc ratio of 0.9-1 for the LE and of 0.1-0.2 for the RE. Paroxetine treatment was suspended, and after 48 h IOP was 10 mm Hg in both eyes (BE). ND-YAG laser iridotomy was performed in BE. In the subsequent visit, IOP was 25 mm Hg in the RE and 41 mm Hg in the LE; on her own initiative the patient had resumed paroxetine treatment. After requesting the patient again to stop taking the anti-depressant, IOP was 10 mm Hg in BE in the next exam 48 h later. CONCLUSIONS: As far as we are aware, there are no other reports of chronic angle-closure glaucoma related to the use of paroxetine. We thus consider that, before initiating treatment with this drug, patients should be informed of its potential ocular risks and they should be subjected to an ophthalmologic examination before its use is authorized.