Maculopathy Associated with Tacrolimus (FK 506)

A 63-year-old man with a history of liver transplantation presented to our clinic complaining of visual disturbance. He had been receiving tacrolimus (FK 506) for 30 months (6 mg/day for 2 years and 3 mg/day for 6 months); he reported that the visual disturbance began while taking tacrolimus. A full ophthalmologic examination and electrophysiologic and imaging studies were performed. The best corrected visual acuity was 0.1 in both eyes. There were no abnormal finding in the anterior segment, pupillary reflexes were normal and, there was no swelling in either optic disc. Although the foveal reflex was slightly decreased, fluorescein angiography revealed non-specific signs, with the exception of a window defect. A multifocal electro-retinogram revealed decreased amplitude of the central ring. A Swedish interactive threshold algorithm-standard 10-2 visual field test revealed a central scotoma. These findings suggest that tacrolimus may result in maculopathy. Therefore, careful ophthalmologic examination is necessary in the patients taking tacrolimus.

Delayed Suprachoroidal Hemorrhage After Ahmed Valve Implantation for Neovascular Glaucoma

PURPOSE: To report the case of delayed suprachoroidal hemorrhage after Ahmed valve implantation in a neovascular glaucoma (NVG) patient. CASE SUMMARY: A 74-years-old male visited the hospital with ocular pain in the left eye. He had a history of vitrectomy and Intraocular lens (IOL) scleral fixation due to trauma in the left eye. NVG was diagnosed and Ahmed valve was implanted in his left eye. Three days later, hypotony occurred with all quadrant choroidal detachment. Next day, raised intraocular pressure (IOP) was checked and anterior chamber was flat on slit lamp examination. Vitreous hemorrhage and suprachoroidal hemorrhage were suspected. We performed anterior chamber formation with viscoelastics. The anterior chamber became deeper and hemorrhage gradually decreased. A month later, the patient visited us with severe ocular pain. Raised IOP and shallow anterior chamber due to moderate hyphema and anteriorly placed IOL were found. Retinal detachment was suspected on B-scan. Vitrectomy, IOL removal, silicone oil insertion, and Ahmed valve removal were performed. CONCLUSIONS: We report we experienced one patient of delayed suprachoroidal hemorrhage after Ahmed valve implantation and he had poor prognosis.