Toxic retinopathy and optic neuropathy in long-term tacrolimus intake

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Abstract

Tacrolimus is an effective immunosuppressive agent that is widely used in transplant surgery. Rare complications of its usage include optic neuropathy or maculopathy development.

AIM: To present a clinical case of tacrolimus-induced optic neuropathy and retinopathy

CLINICAL CASE. A family with a 17-year-old boy was referred to Helmoltz National Medical Research Center of Eye Diseases with complaints of sudden painless decreased vision in his right eye. The best-corrected visual acuity was the right eye of 0.3 and the left eye of 1.0. Ophthalmoscopy of his right eye revealed pigment mottling in the macula and paramacular region, mid-peripheral patchy pigment deposition in 2, 4, and 8 clock meridians. No pathological findings were revealed in his fellow eye. From the anamnesis, 15 years ago, the patient underwent liver transplantation (Alagille syndrome). From the moment of surgery to the date he received tacrolimus. Optical coherence tomography highlighted foveal smoothing, ellipsoid zone and retinal pigment epithelium disruption, macular and paramacular choroid thinning, and neuroretinal rim thickening. Computed microperimetry revealed a significantly decreased sensitivity in the central retinal zone of the right eye. Autofluorescence examination showed multiple punctate hypoautofluorescent spots in the macula and paramacula in the right eye, as well as hyperautofluorescent zones in the posterior pole in both eyes. Electric activity analysis has revealed decreased full-field electroretinogram parameters and P100 amplitude in visually-evoked potentials in the right eye and a decreased a-wave full-field electroretinogram of the left eye. The data provided by the parents suggest that the target tacrolimus concentration in plasma was exceeded 2 times just before the patient noticed vision impairment. Differential diagnoses included infectious and non-infectious posterior uveitis.

CONCLUSION: The first case of combined retinopathy and optic neuropathy in adolescents induced by long-term tacrolimus treatment was described.

About the authors

Ekaterina V. Denisova

Helmholtz National Medical Research Center of Eye Diseases

Author for correspondence.
Email: deale_2006@inbox.ru
ORCID iD: 0000-0003-3735-6249

MD, PhD Researcher, Department of children’s eye pathology

Russian Federation, 14/19, Sadovaya-Chernogriazskaya street, Moscow, 105062

Ilya V. Myshko

Helmholtz National Medical Research Center of Eye Diseases

Email: mowlysh@yahoo.com
ORCID iD: 0000-0002-1354-6390

resident doctor

Russian Federation, 14/19, Sadovaya-Chernogriazskaya street, Moscow, 105062

Margarita S. Ivanova

Helmholtz National Medical Research Center of Eye Diseases

Email: hibarak2012@gmail.com
ORCID iD: 0000-0001-6567-0708

ophthalmologist

Russian Federation, 14/19, Sadovaya-Chernogriazskaya street, Moscow, 105062

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Supplementary files

Supplementary Files
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1. JATS XML
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2. Fig. 1. Fundus photos of the right (a) and left (b) eye of the patient. Pigment mottling in macula and paramacula is seen in the right eye.

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3. Fig. 2. OCT. Macular thickness map of the right (a) and left (b) eye.

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4. Fig. 3. OCT of the retina. a — right eye. b — left eye is normal.

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5. Fig. 4. OCT. Comparative map of the neuroretinal rim thickness profile of the right (a) and left (b) eye. Neuroretinal rim thickening in the right eye is seen. White arrows represent significant thinning of the choroid comparing to left eye (yellow arrows).

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6. Fig. 5. OCT-angiography of the right (a) and left eye (b), respectively. red line — foveal avascular zone In the right eye; white arrows indicate flow voids.

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7. Fig. 6. Computed microperimetry of the right (a) and left (b) eye of the patient. Standard screening pattern.

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8. Fig. 7. Fundus autofluorescence of the right (a) and left (b) eye.

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