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Author Spotlight: Understanding Retinal Vessel Resilience and Disease Progression
Published on: January 12, 2024
DIDANOSINE RETINAL TOXICITY.
Sara J Haug1, Robert W Wong, Shelley Day
1*West Coast Retina Medical Group, San Francisco, California; †Austin Retina Associates, Austin, Texas; ‡Herzig Eye Institute, Toronto, Ontario, Canada; §Associated Retinal Consultants P.C., Royal Oak, Michigan; ¶Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California-Los Angeles, Los Angeles, California; **Bascom Palmer Eye Institute, University of Miami, Miami, Florida; ††Vanderbilt Eye Institute, Vanderbilt University, Nashville, Tennessee; and ‡‡Greater Los Angeles VA Healthcare Center, Los Angeles, California.
Didanosine (ddI) can cause progressive retinal degeneration, even after drug cessation. This study details 19 cases of didanosine toxicity, highlighting ongoing retinal damage in some patients.
Area of Science:
- Ophthalmology
- Toxicology
- Pharmacology
Background:
- Didanosine (ddI) is a nucleoside reverse transcriptase inhibitor used in HIV treatment.
- Retinal degeneration is a known, albeit rare, adverse effect of didanosine therapy.
- Understanding the spectrum and progression of didanosine-induced retinal toxicity is crucial for patient management.
Observation:
- Nine new cases of peripheral chorioretinal degeneration linked to didanosine use were identified.
- Literature review identified 10 additional cases, totaling 19 cases analyzed.
- Patients presented with well-demarcated, severe midperipheral chorioretinal degeneration.
Findings:
- Eight of nine new cases were male, with a median age of 54.
- Visual acuity ranged from 20/20 to 20/32.
- Three new cases showed progressive retinal atrophy despite discontinuing didanosine.
- Literature cases showed similar chorioretinal findings, with 70% being male and an average age of 26.
Implications:
- Didanosine toxicity can lead to irreversible retinal damage.
- Retinal degeneration may progress even after didanosine cessation.
- Newer nucleoside reverse transcriptase inhibitors may also pose a risk for mitochondrial DNA damage and subsequent chorioretinal degeneration.
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