Unilateral acute anterior uveitis with macular edema following the use of sildenafil citrate in a patient with HLA-B27 positivity

Jonathan Regenold; Hashem Ghoraba; Amir Akhavanrezayat; Wataru Matsumiya; Azadeh Mobasserian; Irmak Karaca; Moosa Zaidi; Brandon Pham; Quan Dong Nguyen

doi:10.1016/j.ajoc.2021.101228

Unilateral acute anterior uveitis with macular edema following the use of sildenafil citrate in a patient with HLA-B27 positivity

Am J Ophthalmol Case Rep. 2021 Oct 27:24:101228. doi: 10.1016/j.ajoc.2021.101228. eCollection 2021 Dec.

Authors

Jonathan Regenold¹, Hashem Ghoraba¹, Amir Akhavanrezayat¹, Wataru Matsumiya^{1

2}, Azadeh Mobasserian¹, Irmak Karaca¹, Moosa Zaidi¹, Brandon Pham¹, Quan Dong Nguyen¹

Affiliations

¹ Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA.
² Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan.

Abstract

Purpose: To present a case of acute anterior uveitis with macular edema associated with sildenafil citrate use in an HLA-B27 positive patient.

Observations: A 54-year-old Caucasian male presented at an ophthalmology tertiary center with complaint of pinkish discoloration, irritation, and photophobia in the left eye (OS). He noted that these symptoms appeared one day after using sildenafil for the first time to treat his erectile dysfunction. The patient had no significant ocular history besides refractive surgery in both eyes (OU) and his medical history was insignificant. Best-corrected visual acuity (BCVA) was 20/20 in the right eye (OD) and 20/25 in OS. Slit-lamp-examination (SLE) demonstrated trace cells and 1+ flare in the anterior chamber (AC) in OS and was nonrevealing in AC in OD. Spectral domain optical coherence tomography (SD-OCT) showed parafoveal subretinal hyperreflective deposits in OU. The patient was diagnosed with acute anterior uveitis (AAU) in the left eye and was placed on topical prednisolone acetate.At 2-week follow-up, the patient reported that his eye symptoms had improved since starting topical steroids but worsened again two days after he had used sildenafil for a second time. In OS, best-corrected visual acuity (BCVA) worsened to 20/40, and SLE revealed 1+ cells and 1+ flare in AC. SD-OCT revealed cystoid macular edema only in OS. Fluorescein angiography showed mild staining around the optic disc and significant macular leakage in OS and minimal macular leakage in OD. Uveitis evaluations revealed that the patient was human leukocyte antigen-27 (HLA-B27) positive. The patient was asked to remain off sildenafil and continue topical prednisolone acetate. At 3-month follow-up, BCVA improved to 20/20 in OS with no evidence of active inflammation.

Conclusions and importance: Sildenafil citrate use might be associated with new onset of intraocular inflammation in predisposed patients. Further studies are necessary to establish this relationship.

Keywords: Acute anterior uveitis; HLA B27; Macular edema; PDE5 inhibitors; Sildenafil citrate; Viagra.

Publication types

Case Reports

Grants and funding

P30 EY026877/EY/NEI NIH HHS/United States