Maculopathy associated with tacrolimus (FK 506)

Area of Science:

• Ophthalmology
• Nephrology
• Immunology

Background:

• Tacrolimus (FK 506) is a vital immunosuppressant medication used post-liver transplantation.
• Long-term use of tacrolimus can be associated with various side effects.
• Visual disturbances are a potential, though less common, adverse effect requiring investigation.

Observation:

• A 63-year-old male liver transplant recipient on tacrolimus presented with progressive visual disturbance.
• Ophthalmologic examination revealed reduced visual acuity (0.1 OU) and a slightly decreased foveal reflex.
• Ancillary tests including fluorescein angiography, multifocal electroretinogram, and visual field testing indicated central retinal dysfunction.

Findings:

• Diagnostic findings suggestive of tacrolimus-induced maculopathy were observed.
• Specifically, a central scotoma on visual field testing and decreased central amplitude on multifocal electroretinogram were noted.
• Fluorescein angiography showed non-specific signs with a notable window defect.

Implications:

• This case highlights a potential link between tacrolimus therapy and the development of maculopathy.
• Ophthalmologists and transplant physicians should consider tacrolimus-induced maculopathy in patients presenting with visual symptoms.
• Routine ophthalmologic screening is recommended for patients on long-term tacrolimus treatment to monitor for ocular toxicity.