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Acetylcholine Re-Challenge After Intracoronary Nitroglycerine Administration
Published on: April 4, 2022
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Paramacular Acute Middle Maculopathy Associated with Glyceryl Trinitrate
Tryfon Rotsos1, Ioannis Giachos1, Konstantinos Tyrlis1
11st Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece.
Case Reports in Ophthalmological Medicine
|September 30, 2021
Summary
Nitroglycerin ointment can cause Paracentral Acute Middle Maculopathy (PAMM), a vision-threatening condition. Prompt discontinuation of the ointment led to symptom resolution and visual recovery in a reported case.
Area of Science:
- Ophthalmology
- Toxicology
- Medical Imaging
Background:
- Nitroglycerin (GTN) is widely used for various medical conditions.
- Ophthalmic side effects of topical GTN are rarely reported.
- Paracentral Acute Middle Maculopathy (PAMM) is a condition affecting the macula.
Observation:
- A 50-year-old patient presented with sudden vision loss and scotoma after using 0.2% GTN ointment for an anal fissure.
- Ophthalmic examination revealed retinal venous changes and parafoveal lesions.
- Advanced imaging (SS-OCT, OCT-A, FA) showed specific retinal layer abnormalities and capillary plexus dropout.
Findings:
- The patient was diagnosed with nitroglycerin-induced PAMM.
- Discontinuation of GTN ointment resulted in symptom resolution and stable visual acuity over 8 months.
- Optical coherence tomography confirmed resolution of retinal lesions and thinning of specific retinal layers.
Implications:
- This case highlights an unrecognized side effect of topical nitroglycerin.
- It underscores the importance of considering medication history in patients with unexplained visual disturbances.
- Further research is needed to establish a dose-dependent relationship between GTN and retinal vascular abnormalities.
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