J Korean Ophthalmol Soc.  2015 Sep;56(9):1473-1478. 10.3341/jkos.2015.56.9.1473.

A Case of Transient Color Anomaly and Persistent Visual Field Defect after Sildenafil Citrate Overdose

• Kim P
• Kim SY

• KMID: 2214567
• DOI: http://doi.org/10.3341/jkos.2015.56.9.1473

Abstract

PURPOSE
Sildenafil citrate, is an oral tablet demonstrating efficacy for maintaining an erection in males with erectile dysfunction by inhibiting phosphodiesterase type 5 (PDE5). In the present study, we report 1 case of a transient color anomaly with visual field defect after an overdose of sildenafil citrate.
CASE SUMMARY
One patient, a 39-year-old female, with no significant medical history other than previous major depressive disorder, visited an outpatient department due to the visual field defect that began after taking 30 tablets of sildenafil citrate (50 mg) 3 days earlier. A number of ophthalmologic tests were administered including visual acuity test, color vision test, fundus photography and the measurement of retinal structure with optical coherent tomography and her condition was monitored. The best corrected visual acuity was 1.0 in both right and left eyes in her first visit. The color anomaly and a central scotoma of both eyes were detected in the visual field test, while significant signs were not observed after evaluation using optical coherent tomography and fundus photography. After 5 weeks, the visual acuity was not affected, the color anomaly symptom disappeared and the focal visual field defect was present although improved.
CONCLUSIONS
Transient color anomaly and persistent central scotoma caused by an overdose ingestion of sildenafil has not been reported in Korea, The related mechanisms may involve the inhibition of PDE5 on ganglion cells and bipolar cells in the retina and interruption of phosphodiesterase type 6 (PDE6) function in both rods and cones.

Keyword

Color anomaly; Sildenafil citrate; Visual field defect

MeSH Terms

Adult
Citric Acid*
Color Vision
Cyclic Nucleotide Phosphodiesterases, Type 6
Depressive Disorder, Major
Eating
Erectile Dysfunction
Female
Ganglion Cysts
Humans
Korea
Male
Outpatients
Photography
Photoreceptor Cells, Vertebrate
Retina
Retinaldehyde
Scotoma
Tablets
Visual Acuity
Visual Field Tests
Visual Fields*
Sildenafil Citrate
Citric Acid
Cyclic Nucleotide Phosphodiesterases, Type 6
Retinaldehyde
Tablets

Figure

• 

  Figure 1. Fundus photographs at the first visit. These show no specific lesion on the right eye (A) and left eye (B).

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  Figure 2. (A, B, C, D) Initial (upper) and (E, F, G, H) after 5 weeks (below) optical coherent tomography showed no abnormality on macula and optic disc. RNFL = retinal nerve fiber layer; TS = superotemporal; NS = superonasal; T = tempora ; G = general; N = nasal; TI = inferotemporal; NI = inferonasal; TMP = temporal; SUP = superior; NAS = nasal; INF = inferior.

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  Figure 3. The patient’s visual field tests. (A, B) Initial (1st row), (C, D) after 1st week (2nd row) (E, F) and 5th week (3rd row) showed central scotoma on both eyes. POS = positive; NEG = negative; ASB = apostilb; SITA = Swedish Interactive Threshold algorithm; RX = prescription; DS = diopter sphere; DC = diopter cylinder; GHT = glaucoma hemifield test; MD = mean devia-tion; PSD = pattern standard deviation.

Reference

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