Résumé
Descrevemos o caso de uma paciente, de 53 anos, com quadro de oclusão de ramo venoso da retina após receber seis infusões de infliximabe (3 mg/kg/dose), para tratamento de artrite reumatóide. A investigação clínica e laboratorial sobre distúrbios de coagulação, cardiopatias e sinais de hipertensão arterial crônica foi negativa. A relação temporal do uso de infliximabe e o desenvolvimento do quadro de oclusão de ramo pode indicar um possível efeito adverso da medicação.
A case of a 53 year-old female patient who developed branch retinal vein occlusion after six 3 mg/kg Infliximab infusions for rheumatoid arthritis treatment is reported. Hematological disorders, cardiopathy and chronic systemic hypertension evaluation were negative. The relationship between the infliximab therapy and the development of retinal vein occlusion raises awareness of the possibility of a potential side effect of this medication.
Sujets)
Femelle , Humains , Adulte d'âge moyen , Anticorps monoclonaux/effets indésirables , Antirhumatismaux/effets indésirables , Occlusion veineuse rétinienne/induit chimiquement , Angiographie fluorescéinique , Acuité visuelleRésumé
A 75-year-old female was commenced on sildenafil for the treatment of pulmonary arterial hypertension (PAH) secondary to chronic obstructive pulmonary disease (COPD). She reported blurring of vision within 72 hours after starting treatment and was found to have a central retinal vein occlusion (CRVO). Such an occurrence is the second case reported to date, and we review the possible mechanisms and literature on the subject.
Sujets)
3',5'-Cyclic-GMP Phosphodiesterases/antagonistes et inhibiteurs , Sujet âgé , Diagnostic différentiel , Femelle , Humains , Hypertension pulmonaire/traitement médicamenteux , Inhibiteurs de la phosphodiestérase/effets indésirables , Inhibiteurs de la phosphodiestérase/usage thérapeutique , Pipérazines/effets indésirables , Pipérazines/usage thérapeutique , Purines/effets indésirables , Purines/usage thérapeutique , Occlusion veineuse rétinienne/induit chimiquement , Occlusion veineuse rétinienne/diagnostic , Sulfones/effets indésirables , Sulfones/usage thérapeutiqueRésumé
O interferon alfa (INF alfa) é droga atualmente utilizada no tratamento de várias doenças sistêmicas, como a hepatite C crônica. A ribavirina quando associada ao interferon alfa aumenta muito a resposta ao tratamento. Estima-se que a infecção crônica pelo vírus da hepatite C afete 170 milhões de pessoas no mundo, muitas delas em uso dessas medicações. A forma típica da retinopatia associada ao interferon alfa apresenta exsudatos algodonosos e hemorragias intra-retinianas. Há vários relatos de alterações oculares associadas ao uso do interferon alfa. Este trabalho descreve um caso de oclusão de veia central da retina em olho direito, com hemorragias no olho contralateral, em paciente usuária dessas medicações por dois anos. O caso descrito expõe em um dos olhos o quadro mais freqüente da retinopatia associada ao uso de interferon alfa (hemorragias de fundo) e no olho contralateral, uma apresentação muito mais atípica (trombose de veia central da retina). O quadro fundoscópico apresentou melhora com a interrupção da medicação.
Interferon and ribavirin are medications widely used in the treatment of some systemic diseases, mainly hepatitis C. Ribavirin when associated with interferon increases the rate of success of this treatment. There are about 170 million patients with chronic hepatitis C in the world, many in use of these medications. The classic associated retinopathy is described as cotton wool exudates and hemorrhages. Since the first reports, several different ocular disturbances were described in association with interferon. The present case shows a patient whose right eye presented with central retinal vein occlusion and whose left eye presented the typical findings of hemorrhages; prompt resolution after the medications were discontinued.
Sujets)
Humains , Femelle , Adulte d'âge moyen , Antiviraux/effets indésirables , Interféron alpha , Hémorragie de la rétine/induit chimiquement , Occlusion veineuse rétinienne/induit chimiquement , Ribavirine/effets indésirables , Antiviraux/usage thérapeutique , Association de médicaments , Hépatite C chronique/traitement médicamenteux , Interféron alpha , Hémorragie de la rétine/diagnostic , Occlusion veineuse rétinienne/diagnostic , Ribavirine/usage thérapeutiqueRésumé
This is a report of a 31-year old male patient who presented with poor vision of his left eye of one-week duration after the use of two tables of Sildenafil citrate [Viagra] approximatley 24 hours before and 48 hours after the onset of ocular symptoms. Ocular examination was consistent with the diagnosis of systemic central vein occlusion. There was no history of systemic diseases or ocular risk factors for central retinal vein occlusion. To the best of our knowledge, the young man, described here, is the first to be reported to have fulminant central retinal vein occlusion after Sildenafil use. This paper discusses the history, physical examination, and investigations done for the patient