Sildenafil Intoxication Maculopathy: A Hard Diagnosis.

Area of Science:

• Ophthalmology
• Pharmacology

Background:

• Phosphodiesterase type 5 (PDE-5) inhibitors like sildenafil are used for erectile dysfunction.
• Excessive intake of PDE-5 inhibitors can lead to ocular side effects.

Purpose of the Study:

• To describe two cases of maculopathy resulting from sildenafil intoxication.
• To investigate the impact of excessive PDE-5 inhibition on retinal structure and function.

Main Methods:

• Retrospective case study involving ophthalmic examinations, OCT, FAF, FAG/ICG, visual field testing, color vision testing, and electroretinography (ERG).
• Pharmacological analysis was used in one case to identify sildenafil in counterfeit medication.

Main Results:

• Two young men presented with sudden bilateral vision loss, photophobia, and color vision abnormalities after excessive sildenafil use.
• Optical Coherence Tomography (OCT) revealed characteristic changes in the ellipsoid zone (EZ) and external limiting membrane (ELM).
• Visual acuity and OCT findings showed partial recovery over time, indicating a partially reversible condition.

Conclusions:

• Sildenafil intoxication maculopathy affects cone photoreceptor structure and function.
• The condition is characterized by partially reversible visual disturbances and retinal changes.
• Unlabeled PDE-5 inhibitors in counterfeit 'herbal' supplements pose a significant risk.