Tacrolimus-Associated Maculopathy in a Patient Following Kidney Transplantation

Tacrolimus is one of the mainstay medications for renal transplantation patients. Vision loss is a rare but serious adverse effect associated with tacrolimus use. Herein, we report a male patient who developed acute vision loss during hospitalization for slow kidney graft function post-renal transplantation and 19 days after starting tacrolimus. The vision loss was associated with a recent rise in tacrolimus levels that required dose adjustment. The workup excluded cortical blindness and showed evidence of a newly developed bilateral central white cloudy inner retinal opacification resembling a cherry red spot on fundus examination. Tacrolimus toxicity was suspected, and the medication was replaced with cyclosporin. Follow-up was remarkable for mild improvement in the patient's vision and disappearance of structural changes on fundoscopy in both eyes. These findings are in keeping with a diagnosis of ischemic maculopathy. This is the first case of bilateral severe early-onset tacrolimus-associated ischemic maculopathy. According to our workup, this disease can be explained by a vasoocclusive accident at the arteriolar and venular level of the ciliomacular vascular system.