Retinal Evaluation of Patients on Chronic Amiodarone Therapy

Chan

Survey of Ophthalmology

et al. 2007

Abstract. Multifocal electroretinography (mfERG) is an investigation that can simultaneously measure multiple electroretinographic responses at different retinal locations by cross-correlation techniques. mfERG therefore allows topographic mapping of retinal function in the central 40--50 of the retina. The strength of mfERG lies in its ability to provide objective assessment of the central retinal function at different retinal areas within a short duration of time. Since the introduction of mfERG in 1992, mfERG has been applied in a large variety of clinical settings. This article reviews the clinical applications of mfERG based on the currently available evidence. mfERG has been found to be useful in the assessment of localized retinal dysfunction caused by various acquired or hereditary retinal disorders. The use of mfERG also enabled clinicians to objectively monitor the treatment outcomes as the changes in visual functions might not be reflected by subjective methods of assessment. By changing the stimulus, recording, and analysis parameters, investigation of specific retinal electrophysiological components can be performed topographically. Further developments and consolidations of these parameters will likely broaden the use of mfERG in the clinical setting.

Section: Amiodaronementioning

confidence: 99%

The Clinical Applications of Multifocal Electroretinography: A Systematic Review

Chan

Survey of Ophthalmology

et al. 2007

American Journal of Ophthalmology Case Reports

“…While a cause and effect relationship has not been proven in the literature, 10 we believe that retinal surgeons should be cautious when performing pars plana vitrectomy and membrane peel surgery on patients using amiodarone because of its potential photosensitizing effects. The possibility of retinal phototoxicity should be discussed with the patient pre-operatively and an attempt to minimize operative time, and exposure to light should be made.…”

Section: Discussionmentioning

confidence: 88%

“… 8 Previous studies have failed to show any retinal side effects of amiodarone in vivo. 9 , 10 In vitro studies have, however, demonstrated that RPE cells treated with amiodarone have decreased survival when exposed to UV radiation. 11 Therefore, given that amiodarone deposits are found in retinal pigment epithelial cells and ganglion cells, and that amiodarone has photosensitizing properties on the skin and in RPE cells in vitro, there is a theoretical risk of retinal phototoxicity.…”

Section: Discussionmentioning

confidence: 99%

Amiodarone: A potential risk factor for retinal phototoxicity

Joshi

Gill

2017

PurposeTo report the only known case, to our knowledge, of amiodarone induced retinal phototoxicity following vitrectomy surgery.ObservationsA 66-year-old male presented with visual acuity of 20/150 OS secondary to an epiretinal membrane (ERM). Patient was on oral amiodarone for atrial fibrillation. Baseline spectral domain optical coherence tomography (SD-OCT) revealed an ERM with retinal thickening and schisis. The patient underwent an uncomplicated pars plana vitrectomy and membrane peel using standard vitrectomy settings and illumination. Triamcinolone was used to stain the ERM intraoperatively. ICG was not used. On post-operative day one, vision was count finger (CF) at 1′. At post-operative week one, vision was unchanged and SD-OCT showed macular edema. At post-operative month one, vision remained CF at 1′ and macular edema resolved with residual pigmentary changes and subretinal fibrosis resembling phototoxic damage. SD-OCT at one month showed resolution of macular edema, retinal pigment epithelium hyperplasia and an indistinct ellipsoid layer. Fluorescein angiography did not show any neovascularization. At three month follow-up, patient's vision, exam and OCT findings remained unchanged.Conclusions and importanceMany pharmacologic agents have the ability to alter a patient's sensitivity to solar or artificial radiation. Drugs act as photosensitizers that lead to photochemical damage. Amiodarone has been reported to have such photosensitizing properties in humans. This report describes a case of retinal phototoxicity from intraoperative light exposure photosensitized by systemic amiodarone use.

“…Based on the observation that several patients receiving amiodarone developed atypical pigmentary maculopathy, Shaikh et al [85] evaluated the mfERG responses of 11 patients on chronic amiodarone therapy in order to investigate whether there are any correlations between this drug and the retinal disease. mfERG P1 amplitudes were normal in all but 2 patients.…”

Section: Amiodarone Retinopathymentioning

confidence: 99%

The Role of Multifocal Electroretinography in the Assessment of Drug-Induced Retinopathy: A Review of the Literature

Dettoraki

Moschos²

2016

Ophthalmic Res

Multifocal electroretinography (mfERG) is an objective, noninvasive examination for the assessment of visual function. It enables the stimulation of multiple retinal areas simultaneously and recording of each response independently, providing a topographic measure of retinal electrophysiological activity in the central 40-50° of the retina. A clinical application of mfERG represents the assessment of retinal toxicity associated with systemic medications. Drug-induced retinopathy represents a disease that, although not common, requires early recognition: if not detected early, it may progress and cause irreversible retinal dysfunction with subsequent visual impairment. This review aims to evaluate the use of mfERG in the assessment of retinal dysfunction associated with various systemic pharmacological agents based on the currently available literature. The most commonly recognized systemic medications affecting retinal function are included, such as chloroquine and hydroxychloroquine, vigabatrin, deferoxamine, ethambutol, interferon-α, tamoxifen, digoxin, sildenafil, canthaxanthin, amiodarone and nefazodone. The role of mfERG in the early diagnosis of retinal toxicity and the evaluation of disease severity is reviewed, as well as its clinical value in monitoring disease progression or recovery after drug cessation.