Cyclosporin A Induced Optic Neuropathy

ABSTRACT

PURPOSE: Cyclosporin A (CsA) is widely used as a prophylactic and therapeutic agent against a graft- versus-host disease following bone marrow transplantation. Herein, a case of cyclosporin-induced optic neuropathy, after bone marrow transplantation, is reported, which to our knowledge has never previously been reported. METHODS: A 43-year-old man, with acute myelogenous leukemia, who was treated with bone marrow transplantation one month previously, also with immunosuppressive medication, presented with decreased visual acuity and nystagmus in both eyes. He had been administerd CsA for about one month, from one day before the bone marrow transplantation. A fundus examination, visual field, electroretinography, and brain MRI were performed. RESULTS: At the first ocular examination, his visual acuity was markedly decreased in both eyes. On fundus examination, an edematous optic nerve head, with superficial peripapillary hemorrhage, was noticed in both eyes. A large central scotoma was seen in both eyes on a visual field examination. The amplitude of the b-wave in the scotopic ERG was slightly decreased in both eyes. However, there were no abnormal findings in the other examinations. Cyclosporin-induced optic neuropathy was suspected as the cause of the decreased visual acuity, so the CsA was discontinued and replaced by FK506(tacrolimus). On the second day after the discontinuation of the CsA, the optic disc edema improved, and the visual acuity of both eyes recovered almost too normal. CONCLUSIONS: It is important to monitor the neuro-ophthalmologic and neurologic signs of bone marrow transplant closely in patients taking cyclosporin.