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Ocular toxicity assessment of chronic sildenafil therapy for pulmonary arterial hypertension

  • Medical Ophthalmology
  • Published:
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Abstract

Purpose

The aim of this study was to investigate possible functional and structural ocular changes caused by chronic sildenafil therapy to treat pulmonary arterial hypertension (PAH).

Methods

Case–control study included patients with pulmonary arterial hypertension: chronically using sildenafil and without sildenafil treatment. A comprehensive ophthalmologic exam including ectoscopy, extrinsic ocular motility, logMAR visual acuity measurement, contrast sensitivity test, color test, anterior segment biomicroscopy, Schirmer test 1, intraocular pressure, fundus exam under pupil dilation, fundus pictures, time domain and spectral domain optical coherence tomography, ocular Doppler ultrasound were performed. Full-field electroretinography (ERG) was tested for each eye in a subgroup of sildenafil-treated patients.

Results

Twenty patients from each group were tested. Bilateral severe keratitis was found in seven (35 %) patients under sildenafil therapy. Lacrimal film break-up time (BUT) was significantly reduced (p = 0.006 respectively) and Doppler ultrasound showed a reduced resistance index of the central retinal artery in the group of sildenafil users (p = 0.019). No diffuse retinal functional abnormalities were found in ERG in treated patients. Visual acuity, contrast sensitivity and color discrimination were normal in both groups. No abnormalities were found in both time-domain and spectral-domain OCT for retinal parameters.

Conclusions

One-third of the treated PAH group showed severe bilateral keratitis. This finding could be related to connective tissue abnormalities usually present in patients with this condition that might be exacerbated with the sildenafil usage. The resistance index of the central retinal artery was diminished in the chronic users group and it could be associated to the vasodilation caused by the medication in the choroidal vessels. An ophthalmic assessment for these patients is recommended to diagnose and treat possible ocular surface and choroidal blood flow abnormalities caused by sildenafil.

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Authors and Affiliations

  1. Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo – UNIFESP, Hospital São Paulo, Rua Botucatu, 822 - Vila Clementino, São Paulo, 04023-062, SP, Brasil

    Licia Matieli, Adriana Berezovsky, Solange Rios Salomão, Norma Allemann, Elisabeth Nogueira Martins, Flavio E. Hirai, Maira S. A. Morales & Denise de Freitas

  2. Divisão de Pneumologia, Departamento de Clínica Médica, Escola Paulista de Medicina, Universidade Federal de São Paulo – UNIFESP, Hospital São Paulo, São Paulo, SP, Brasil

    Jaquelina Ota-Arakaki

Authors
  1. Licia Matieli
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  2. Adriana Berezovsky
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  3. Solange Rios Salomão
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  4. Norma Allemann
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  5. Elisabeth Nogueira Martins
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  6. Flavio E. Hirai
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  7. Jaquelina Ota-Arakaki
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  8. Maira S. A. Morales
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  9. Denise de Freitas
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Corresponding author

Correspondence to Licia Matieli.

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Funding

Financial support was received from CAPES, process number 72-24203. The sponsor had no role in the design or conduction of this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Informed consent

All procedures performed in the study were in accordance with the Committee on Ethics in Research (number 139/11) from Universidade Federal de São Paulo (UNIFESP) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all participants included in the study.

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Matieli, L., Berezovsky, A., Salomão, S.R. et al. Ocular toxicity assessment of chronic sildenafil therapy for pulmonary arterial hypertension. Graefes Arch Clin Exp Ophthalmol 254, 1167–1174 (2016). https://doi.org/10.1007/s00417-016-3352-8

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  • DOI: https://doi.org/10.1007/s00417-016-3352-8

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