518 Choriorétinopathie séreuse centrale récidivante chez deux patients sous inhibiteurs de phosphodiestérase pour dysfonctionnement érectile

Abstract

Central serous chorioretinopathy typically affects young and middle aged men with type-A personality under stressful events. It has been occasionally related with exposure to increased levels of endogenous or exogenous glucocorticoids, but other associations are possible. We present two cases of recurrent central serous chorioretinopathy in two men taking phosphodiesterase inhibitors. In both cases, chorioretinopathy appeared after intake of the inhibitor, resolved once the latter discontinued, and re-appeared when the inhibitor was restarted. First case: A 56-year-old white male presented for blurred vision and micropsia in left eye. He had been using vardenafil over the last 6 weeks. Visual acuity of left eye was 20/25. Left fundus examination revealed a bullous central serous chorioretinopathy. Three months after vardenafil cessation, fundus alterations completely resolved and visual acuity returned to 20/20. Fifteen months later, after restarting vardenafil, he consulted with a 2-month history of progressive left eye vision reduction, and micropsia. Visual acuity was 20/32. Left fundus examination showed a new central serous macular detachment, confirmed by OCT. Once vardenafil re-stopped, chorioretinopathy regressed within 3 months. Second case: A 67- year-old white male presented for blurred vision in right eye progressively deteriorating over a 1-month period. He was taking tadalafil for the last 2 months. Visual acuity of right eye was 20/32 and right fundus examination and fluorescein angiography evidenced a central serous chorioretinopathy. Four months after stopping tadalafil, complete resolution of chorioretinopathy with normal fundus and OCT image and 20/20 visual acuity was observed. Six months later, the patient restarted tadalafil and chorioretinopathy recurred in his right eye within one month, with visual acuity returning to 20/32. Subsequent controls after stopping tadalafil showed improvement in OCT and visual acuity. Central serous chorioretinopathy was previously described in a patient taking sildenafil citrate, but no association was known with either vardenafil or tadalafil. The presented two cases of central serous chorioretinopathy after intake of vardenafil or tadalafil suggest that this condition should be added to the side effects of phosphodiesterase inhibitors.