Author: Laura Cristina Mesones Ruiz (Spain)
Co-authors: Francisco Hermoso Fernandez, Maria del Carmen González Gallardo
Purpose
To report the findings of a case of maculopathy associated with tacrolimus treatment, a rare complication of the treatment with tacrolimus.
Setting/Venue
Department of Ophthalmology of the San Cecilio University Hospital of Granada, Spain.
Methods
An observational case report. The description of a 41-year-old woman with a maculopathy associated with tacrolimus treatment. We portrait the findings in the retinography, OCT, OCT angiography, computerized campimetry and electroretinogram. We consulted the PubMed data base in search to similar cases.
Results
A 41-year-old woman with a history of kidney transplant consulted for acute wavy vision in the right eye. She had treatment with tacrolimus for 4 months. She had unstable tacrolimus plasmatic levels, and had headache and trembling attributed to tacrolimus. The best corrected visual acuity was 0.8 in the right eye and 1 in the left eye. On the slit lamp examination, the anterior segment did not show significant finding, but the fundoscopy revealed a yellow pigmented lesion in the central macular area in both eyes, the optic nerve did not show pallor or swelling. OCT scanning revealed central subretinal deposits and a small parafoveal pigmented epithelial detachment (PED), without signs of choroidal neovascularisation, more severe in the right eye. OCT-A findings revealed a small ischemic area in correlation with the PED. The filed test showed general loss of sensitivity, more pronounced in the macular area. The neurophysiology test showed as follow: Visual evoked potential demonstrated a mild P100 delay in both eyes, the multifocal ERG showed general suppression, more marked in the macular region. The ERG showed p50 wave amputation. During the follow up for 2 months the lesions were stable.
Conlusions
Tacrolimus ocular side effects are rare and can be serious. Among the ocular surface alterations that may develop during the treatment with tacrolimus, visual alteration may be associated with alteration in the visual cortex or ocular neuropathy. There is only one case reported of maculopathy, with similar findings to our patient in the ERG, VEP and visual field, but without any alteration on the OCT or the posterior segment observation. This case may support furthermore the association of tacrolimus and the possibility of an alteration in the RPE, cone cells or rod cells, resulting in a maculopathy similar found in treatments with cyclophosphamide. Although the mechanism is unknown, this shows the necessity to perform carefully complete ophthalmologic examinations in patients with this treatment and any visual disturbance.
Financial Disclosure
None
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