PURPOSE: To present an atypical case of paracentral acute middle maculopathy occurred upon awakening in the morning within hours after phosphodiesterase-5 (PDE-5) inhibitor consumption at bedtime. METHODS: Multimodal retinal imaging findings, including fluorescein angiography, spectral domain optical coherence tomography, optical coherence tomography angiography, and microperimetry of a particular case of paracentral acute middle maculopathy lesion that follow the distribution of the cilioretinal artery. RESULTS: A 52-year-old healthy man presented with an acute paracentral scotoma in his left eye upon awakening in the morning, after the use of a PDE-5 inhibitor pill the previous night. Spectral domain optical coherence tomography illustrated a hyperreflective band-like lesion at the level of the inner nuclear layer, consistent with a diagnosis of paracentral acute middle maculopathy, along the course of the cilioretinal artery that appeared normally perfused with fluorescein angiography. Optical coherence tomography angiography showed a perfusion deficit and capillary pruning of the retinal deep capillary plexus, with preserved intermediate capillary plexus, that colocalized with the paracentral scotoma confirmed with microperimetry. CONCLUSION: To our knowledge, this is the first report of paracentral acute middle maculopathy after the use of PDE-5 inhibitor. Nocturnal arterial hypotension exacerbated by the vasodilatory effect of the PDE-5 inhibitor may have caused transient cilioretinal artery hypo/nonperfusion and insufficiency. Paracentral acute middle maculopathy may represent the earliest form of ischemia in the central macular region, occurring after a milder vascular insult.

Sebastiani, S., Pellegrini, M., Giannaccare, G., Sarraf, D. (2021). PARACENTRAL ACUTE MIDDLE MACULOPATHY ASSOCIATED WITH PHOSPHODIESTERASE-5 INHIBITOR THERAPY. RETINAL CASES & BRIEF REPORTS, 15(5), 519-522 [10.1097/ICB.0000000000000839].

PARACENTRAL ACUTE MIDDLE MACULOPATHY ASSOCIATED WITH PHOSPHODIESTERASE-5 INHIBITOR THERAPY

Sebastiani, Stefano;Pellegrini, Marco;Giannaccare, Giuseppe;
2021

Abstract

PURPOSE: To present an atypical case of paracentral acute middle maculopathy occurred upon awakening in the morning within hours after phosphodiesterase-5 (PDE-5) inhibitor consumption at bedtime. METHODS: Multimodal retinal imaging findings, including fluorescein angiography, spectral domain optical coherence tomography, optical coherence tomography angiography, and microperimetry of a particular case of paracentral acute middle maculopathy lesion that follow the distribution of the cilioretinal artery. RESULTS: A 52-year-old healthy man presented with an acute paracentral scotoma in his left eye upon awakening in the morning, after the use of a PDE-5 inhibitor pill the previous night. Spectral domain optical coherence tomography illustrated a hyperreflective band-like lesion at the level of the inner nuclear layer, consistent with a diagnosis of paracentral acute middle maculopathy, along the course of the cilioretinal artery that appeared normally perfused with fluorescein angiography. Optical coherence tomography angiography showed a perfusion deficit and capillary pruning of the retinal deep capillary plexus, with preserved intermediate capillary plexus, that colocalized with the paracentral scotoma confirmed with microperimetry. CONCLUSION: To our knowledge, this is the first report of paracentral acute middle maculopathy after the use of PDE-5 inhibitor. Nocturnal arterial hypotension exacerbated by the vasodilatory effect of the PDE-5 inhibitor may have caused transient cilioretinal artery hypo/nonperfusion and insufficiency. Paracentral acute middle maculopathy may represent the earliest form of ischemia in the central macular region, occurring after a milder vascular insult.
2021
Sebastiani, S., Pellegrini, M., Giannaccare, G., Sarraf, D. (2021). PARACENTRAL ACUTE MIDDLE MACULOPATHY ASSOCIATED WITH PHOSPHODIESTERASE-5 INHIBITOR THERAPY. RETINAL CASES & BRIEF REPORTS, 15(5), 519-522 [10.1097/ICB.0000000000000839].
Sebastiani, Stefano; Pellegrini, Marco; Giannaccare, Giuseppe; Sarraf, David
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/680277
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