Poppers Maculopathy Research Articles

“Poppers Maculopathy” is an Electrochemical Overload

Poppers maculopaty is a rare retinal disease which is poorly understood. It is characterized by disruption of inner segment/outer segment junction of central cones and yellow foveal lesions causing photophobia, central scotoma and impaired visual acuity

‘Poppers Maculopathy’ and the adverse ophthalmic outcomes from the recreational use of alkyl nitrate inhalants: a systematic review

ABSTRACT Objective The aim of this systematic review and meta-analysis was to provide an overview of reported cases of poppers maculopathy and a statistical analysis of the clinical presentations, anatomical changes and treatment and follow-up of the rare disease. Methods A systematic search of CINAHL, Embase and PubMed databases was conducted, including a search of the grey literature. Data were pooled to provide a summary of the clinical characteristics and outcomes of poppers maculopathy. Studies were critically appraised using the Joanna Briggs Institute or the Authority, Accuracy, Coverage, Objectivity, Date, Significance checklists. Results Of the 493 articles obtained, 32 were included, consisting of 113 participants with a mean age of 40.2. Most patients were male with bilateral maculopathy and presented with either vision loss or a visual disturbance. Cessation of popper use was the most common form of management prescribed. The mean VA at baseline was 0.22 (logMAR units). For those followed-up, the mean VA significantly improved from 0.24 to 0.11 (Z = −5.800, p = <0.001). Bilateral yellow foveal spots were viewed on fundoscopy in 53 patients, and a sub-foveal disturbance of the ellipsoid layer was reported on spectral domain optical coherence tomography in 89 patients. By 6 months, SD-OCT anatomical changes mostly improved or resolved. Conclusion Recreational users of poppers who develop maculopathy generally present with vision loss or a visual disturbance secondary to foveal disruption. Patients have a good visual prognosis, with cessation of poppers potentially having a role in improved outcomes. With the high prevalence of use among gay and bisexual men, awareness of related maculopathy and presenting symptoms by clinicians is important to mitigate side effects.

Assessment of the microvasculature in poppers maculopathy

PurposeTo investigate a possible microvascular component of poppers maculopathy (PMP) using optical coherence tomography angiography (OCTA).MethodsTwelve patients suffering from poppers maculopathy were included. Health records, optical coherence tomography (OCT), and OCTA data was gathered and compared to a healthy control group (HC). PMP lesion type was determined by manifestation in OCT. OCTA-based evaluation of retinal vascular plexus and choriocapillaris (CC) was executed. Vessel density (VD) and vessel length density (VLD) in superficial and deep capillary plexus (SCP, DCP), as well as flow deficits (FD), within the foveal avascular zone (FAZ) in CC were assessed.ResultsMedian age of PMP patients was 40 (min 24; max 64) years, all male. Eleven patients presented with ellipsoid zone-type lesions; one patient showed a vitelliform-type lesion. No qualitative microvascular changes between PMP patients and HC were identified. Quantitative values for VD and VLD of SCP and DCP did not differ in between the two groups. The analysis of FDs in CC showed no deviation from PMP patients to HC.ConclusionsNo vascular anomalies in qualitative and quantitative analysis in OCTA were detected in PMP patients. The constitution of the CC within FAZ of PMP patients does not differ from HC when assessed as FD.

Poppers maculopathy as an effect of drug poisoning. A clinical case

In recent years, the range of combined narcotic drugs has widened. New chemical modifications have emerged, including so-called designer drugs, whose action on the body and in particular on the state of vision is increasingly difficult to determine. While the problem of drug abuse is growing drastically, timely detection of a possible toxic damage to the eye induced by drugs and reliable diagnosis differentiating such damage from other etiologies becomes a topical practical issue. The paper presents a clinical case of poppers maculopathy (poppers being a slang name of aromatic volatile alkyl nitrite compounds). Ophthalmological manifestations and differential diagnostic criteria of the damage are described. The mechanisms of action and possible treatment methods are discussed.

Acquired Bilateral Central Vision Loss in a Young Adult Due to “Poppers Maculopathy”

Acquired Bilateral Central Vision Loss in a Young Adult Due to “Poppers Maculopathy”

Multifocal Electroretinography in Patients with Poppers Maculopathy

Maculopathy is a potential side effect of amyl nitrite or "poppers" abuse. It is characterized by a sudden, painless decrease in visual acuity. While the funduscopic changes are subtle, optical coherence tomography shows alterations of the outer retinal layers in the fovea. However, the extent of retinal dysfunction remains poorly understood. We compared the multifocal electroretinogram of 6 patients with poppers maculopathy to that of a control group consisting of 6 healthy subjects. Response densities and implicit times of N1 and P1 were analyzed. Response densities and implicit times of both N1 and P1 were lower in the patients with poppers maculopathy than in the control group, particularly in ring 1 and rings 4 and 5. The only statistically significant finding, however, was a reduced N1 response density of one hexagon in the patient group. No significant differences were found considering the sum response or the averaged rings 1 to 5. Compared to a healthy control group, the multifocal electroretinogram of patients with poppers maculopathy shows no relevant impairment. This contrasts the marked effect of the disease on visual acuity. In clinical practice, poppers maculopathy cannot be diagnosed by multifocal electroretinography.

Clinical Phenotypes of Poppers Maculopathy and Their Links to Visual and Anatomic Recovery

Clinical Phenotypes of Poppers Maculopathy and Their Links to Visual and Anatomic Recovery

Poppers: legal highs with questionable contents? A case series of poppers maculopathy

BackgroundPoppers are volatile alkyl nitrite compounds that are inhaled to enhance sexual experience and for their psychoactive effects. A less well-known side effect is foveal maculopathy, which has emerged following...

“Poppers maculopathy?” in Spain. A new ophthalmological disease

“Poppers maculopathy?” in Spain. A new ophthalmological disease

“Poppers maculopathy?” in Spain. A new ophthalmological disease

IntroductionThe term “poppers” refers to products made of volatile alkyl nitrites used for recreational practices. Clinical case40 year old man reported blurred vision in both eyes and photophobia, and admitted regular use of “poppers”. Best corrected visual acuity was 0.63/1 in both eyes. Bilateral yellowish vitelliform macular lesions were present in both eyes in the funduscopy, as well as a disruption of the IS/OS line in the optical coherence tomography. DiscussionThis is the first case of “poppers maculopathy” registered in Spain. Clinical findings and symptoms are similar to previous reported cases.

«Maculopatía por poppers» en España. Una nueva enfermedad oftalmológica

IntroductionThe term «poppers» refers to products made of volatile alkyl nitrites used for recreational practices. Clinical case40 year old man reported blurred vision in both eyes and photophobia, and admitted regular use of «poppers». Best corrected visual acuity was 0.63/1 in both eyes. Bilateral yellowish vitelliform macular lesions were present in both eyes in the funduscopy, as well as a disruption of the IS/OS line in the optical coherence tomography. DiscussionThis is the first case of «poppers maculopathy» registered in Spain. Clinical findings and symptoms are similar to previous reported cases.

Poppers Maculopathy: Complete Restitution of Macular Changes in OCT after Drug Abstinence

Background: “Poppers” is a slang term for a group of alkyl nitrites that are used as recreational drugs. Their inhalative intoxication leads to muscle relaxation, analgesia, and euphoria. Maculopathy is a rare but serious side-effect. Patients/Methods: Clinical, imaging, and electrophysiological findings of seven patients with maculopathy after consumption of poppers were presented. Results: All seven patients were male with a median age of 35 years (range 28–45 years), the median duration of periodical poppers use until the onset of symptoms was 9.8 years (one day to 25 years). Five of seven patients were HIV-positive, one patient was negative, and the HIV-status of one patient was unknown. Median average of visual acuity at presentation was 20/30 in each eye. In all patients, optical coherence tomography (OCT) showed pathognomonic alterations of the outer foveal retina. One patient showed an almost complete restitution of the maculopathy six months after cessation of drug use and following the oral intake of Lutein. Imaging alterations returned to normal and visual acuity recovered from 20/50 and 20/30 (right and left eye, respectively) to 20/20 on both eyes. Follow up of two other cases showed no relevant functional decline or improvement. Discussion: Toxic maculopathy due to the consumption of poppers is an important differential diagnosis in acute visual loss without clinico-morphological correlate. Optical coherence tomography is the only reliable diagnostic tool in these cases. Complete recovery of visual function and macular morphology is rare, even after cessation of drug abuse. Oral lutein therapy may have a beneficial effect.

Response to Fajgenbaum

Sir, We thank Dr Fajgenbaum1 for his interest in our recent case series of maculopathy in poppers users2 and for debate on this matter with respect to photic maculopathy. The similarity of clinical signs in ‘poppers maculopathy' patients with those described in some patients with photic maculopathy is intriguing and as was also demonstrated in Dr Fajgenbaum's case report. We doubt the suggestion that poppers inhalation could lead to hallucinations or drastically altered consciousness, resulting in entrancement with bright lights or the sun. The psychogenic effects of poppers are well documented, but do not, in our opinion, lead to this sort of behaviour. It is also recognised that poppers use can be linked to abuse of other compounds, which may have more potent hallucinogenic effects. We also agree that as poppers are sometimes used in raves where exposure to unsafe use of laser lights is a potential risk, these matters need to be considered in the differential diagnosis of individuals with acquired foveal defects. To answer the question about substance abuse and exposure to light in our cases, a detailed drug and social history was taken. Cases were questioned about prolonged solar or other lights gazing and which was denied in all cases. As we stated there were several features of our cases that support on the balance of probabilities evidence of causality of poppers maculopathy as based on the Bradford-Hill criteria. Mainster et al3 has provided helpful advice on assessment of alleged retinal laser injury patients and which can also in our opinion be extrapolated to alleged photic retinal injury. Furthermore, it is now increasingly recognised that the signs of alleged solar maculopathy on SD-OCT imaging are varied. As discussed in our paper, it is not possible to prove causality of poppers maculopathy and we agree that differential diagnosis of outer lamellar defects can be challenging4 and that a detailed history should be taken.

Is the mechanism of ‘poppers maculopathy’ photic injury?

'Poppers' is a slang term referring to recreational substances of abuse belonging to the alkyl nitrite family of compounds. Inhalation of the fumes from these volatile nitric oxide (NO) donors may provide a brief sense of euphoria and sexual arousal. Language: en

Adverse ophthalmic reaction in poppers users: case series of ‘poppers maculopathy’

Poppers are a recreational substance of abuse belonging to the alkyl nitrite family of compounds. In the United Kingdom, where they are legal to purchase but illegal to sell for human consumption, 10% of the general population have tried them. They are considered low risk to physical and mental health. Two recent case series from France demonstrated foveal pathology in individuals associated with poppers use. A case series of seven patients presenting to four hospitals in the United Kingdom with visual impairment and maculopathy associated with inhalation of poppers. All patients experienced visual symptoms associated with poppers use. The majority had impaired visual acuity, central scotomata, distortion, or phosphenes. Clinical signs on fundoscopy ranged from normal foveal appearance to yellow, dome-shaped lesions at the foveola. Spectral domain optical coherence tomography (SD-OCT) showed varying degrees of disruption of the presumed inner segment/outer segment (IS/OS) junction. Although poppers have been in use for several decades, in 2007, following legislative changes, there was a change in the most commonly used compound from isobutyl nitrite to isopropyl nitrite. There were no reports of 'poppers maculopathy' before this. Poppers maculopathy may be missed if patients are not directly questioned about their use. The disruption or loss of the presumed IS/OS junction on SD-OCT are a characteristic feature. Further study of maculopathy in poppers users is now needed. Raising public awareness of the ocular risks associated with their use may be necessary.

‘Poppers maculopathy’—an emerging ophthalmic reaction to recreational substance abuse

Sir, ‘Poppers' (alkyl nitrite class of compounds) are inhaled for recreational purposes and may provide a brief rush of euphoria and sexual arousal. In the United Kingdom, poppers are legal to purchase but illegal to sell for human consumption. Poppers are widely used in the gay and ‘nightclubbing' communities. They are regarded as low health risk. In 2008 (due to legislative changes), the most commonly used poppers compound changed from isobutyl nitrite to isopropyl nitrite.1 We report a patient who developed maculopathy following isopropyl nitrite inhalation.