Retinal and Optic Disc Vascular Changes in Patients Using Long-Term Tadalafil: A Prospective Non-Randomized Matched-Pair Study.

Marco Capece,Giuseppe Celentano,Daniela Montorio,Gianluigi Califano,Ciro Imbimbo,Gilda Cennamo,Chiara Comune,Alberto Melchionna,Felice Crocetto,Achille Aveta

doi:10.3390/diagnostics11050802

Abstract

Retinal, choroidal and optic disc vascularity has never been evaluated in patients taking PDE5is long-term. The aim of our study was to evaluate the neurostructural and vascular changes after long-term use of tadalafil, using spectral domain (SD)-optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). In the present clinical trial, 27 patients who have been taking tadalafil 20 mg on alternate days (OAD) for at least 6 months (Group A) were enrolled. The matched group consisted of 27 healthy men (Group B). Both groups of patients underwent SD-OCT to study ganglion cell complex (GCC), retinal nerve fiber layer (RNFL) and choroidal thickness and OCTA for the evaluation of superficial capillary plexus (SCP), deep capillary plexus (DCP), choriocapillaris (CC) and radial peripapillary capillary (RPC). A reduction in SCP, DCP and RPC vessel density was found in patients using tadalafil long-term. Retinal and optic disc toxicity may be detected using modifications of capillary vessel density. Further studies are needed to investigate the possibility of a causal association.

Highlights

Phosphodiesterase type 5 inhibitors (PDE5is) are the first-line treatment for erectile dysfunction (ED) [1,2]
In the present study, 27 patients taking tadalafil 20 mg OAD were enrolled in Group
PDE5is are used to enhance the effect of nitric oxide in increasing the blood flow into the corpus cavernosum

Summary

Introduction

Phosphodiesterase type 5 inhibitors (PDE5is) are the first-line treatment for erectile dysfunction (ED) [1,2]. Despite PDE5is mainly blocking phosphodiesterase 5 (PDE5), a minimal affinity to other types of PDEs has been previously confirmed [2]. It has been established that PDE5is suspend PDE2-4, PDE7-11 and PDE6 activities (10-fold less potent than on PDE5) [3]. The latter control the level of cyclic guanosine monophosphate (cGMP) in retinal rod and cone cells for visual signal transduction. Visual symptoms are well-known side effects of PDE5is; they do not seem to cause permanent toxicity on chorioretinal tissues and photoreceptors [3]

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