Ritonavir and bull’s eye maculopathy: case report

Pinto, Rui; Vila-Franca, Marta; C, Oliveira Afonso; Ornelas, C; Coutinho-Santos, Luísa

doi:10.3205/oc000011

Cited by 4 publications

(3 citation statements)

References 6 publications

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“…Prior case series have documented ritonavir-associated retinopathy 8,14 –21 and corroborate the disease phenotypes observed over the long-term follow-up of patients described in the present series. Given the recent US FDA approval of nirmatrelvir/ritonavir for mild to moderate COVID-19 in adult and pediatric patients, 6,22 this series serves as a reappraisal of the literature to consider this toxicity in the COVID-19 era.…”

Section: Discussionsupporting

confidence: 90%

“…Given the recent US FDA approval of nirmatrelvir/ritonavir for mild to moderate COVID-19 in adult and pediatric patients, 6,22 this series serves as a reappraisal of the literature to consider this toxicity in the COVID-19 era. Common fundus findings observed in prior series of persons with HIV 8,14 –21 include macular atrophy with or without foveal involvement, midperipheral bone spicule-like pigmentary changes, RPE hypertrophy, and intraretinal crystal deposits. These findings are consistent with the macular atrophy pattern observed in our patients.…”

Section: Discussionmentioning

confidence: 83%

“…In addition, prior studies have shown patients with liver disease, such as hepatitis, may be predisposed to ritonavir-associated retinopathy, as observed in Case 2 in the present series. 8,19,23 Therefore, careful consideration should be taken prior to using ritonavir in patients with COVID-19 who have liver comorbidities given that liver injury commonly occurs in patients with COVID-19. 24 While the current use of nirmatrelvir/ritonavir involves short-term, 5-day use, the near-term effects of ritonavir related to the retina have not been reported.…”

Section: Discussionmentioning

confidence: 99%

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Retinopathy Associated With Ritonavir Treatment for HIV Infection: A Case Series Reappraisal in the COVID-19 Era

Nguyen,

Kim,

Collins

et al. 2023

Journal of VitreoRetinal Diseases

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Purpose: To report 3 cases of retinopathy secondary to ritonavir use in the treatment of HIV. Methods: A retrospective review of patient records was performed for data including ophthalmic examination findings, demographic and HIV clinical characteristics, and progression of maculopathy disease . The review identified 3 patients with a history of HIV treated with antiretroviral therapy including ritonavir who had been evaluated for bilateral vision loss in both eyes. Results: A fundus examination of each patient revealed characteristic macular atrophy, and optical coherence tomography demonstrated corresponding central outer retinal atrophy. Uveitis workup results were unremarkable. Given the characteristics of macular atrophy, history of ritonavir use, and the absence of intraocular inflammation, all 3 patients were diagnosed with bilateral ritonavir-associated retinopathy. Each patients’ vision continued to deteriorate, even after the cessation of ritonavir. Conclusions: Ritonavir toxicity should be considered in the differential diagnosis of retinopathy among patients with an exposure history.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

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Retinopathy Associated With Ritonavir Treatment for HIV Infection: A Case Series Reappraisal in the COVID-19 Era

Nguyen,

Kim,

Collins

et al. 2023

Journal of VitreoRetinal Diseases

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Disease of the Year: Differential Diagnosis of Uveitic Macular Edema

Agarwal

Pichi

Invernizzi

et al. 2018

Ocular Immunology and Inflammation

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Uveitic cystoid macular edema (UME) is an important cause of visual morbidity among patients with both infectious and non-infectious uveitis. UME may be associated in more than 30% cases of active uveitis. However, even patients with minimal features of intraocular inflammation may develop recurrent or chronic UME. Therefore, the evaluation and management of UME in patients with uveitis may be challenging. A number of vitreoretinal pathologies may result in UME and accumulation of fluid in the intra-or subretinal space. These need to be carefully distinguished from each other so that appropriate management can be initiated. All types of uveitis, including anterior uveitis (where the primary site of inflammation is not in the posterior segment) can present with UME. Other conditions such as diabetes, and surgery, can present with macular edema. This index review highlights various differential diagnoses of UME and provides illustrative case examples with multimodal imaging evaluation.

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Case Report: Multimodal Imaging of Toxic Retinopathies Related to Human Immunodeficiency Virus Antiretroviral Therapies: Maculopathy vs. Peripheral Retinopathy. Report of Two Cases and Review of the Literature

Hammer

Borruat

2021

Front. Neurol.

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Purpose: We report two patients with toxic retinopathy from either ritonavir or didanosine and reviewed the literature on the topics. We provide an overview of the retinal toxicity of these two antiretroviral drugs in human immunodeficiency virus-positive patients.Methods: First, we performed a retrospective study of the medical charts of two patients examined by us, one with ritonavir maculopathy and one with didanosine peripheral retinopathy. Secondly, we searched the world literature for similar cases through PubMed and Google Scholar, using the terms “HIV,” “AIDS,” “ritonavir,” “didanosine,” “maculopathy,” “retinopathy,” “visual loss,” and “toxicity” to retrieve the appropriate literature on the subject.Results: Patient 1: A 49-year-old woman complained of progressive central visual loss over the past 12 months. History disclosed ongoing ritonavir therapy for the past 11 years. Ritonavir maculopathy was diagnosed, and visual loss increased relentlessly despite cessation of treatment. Patient 2: A 55-year-old man complained of slowly progressive peripheral visual field constriction for the past 5 years. History disclosed didanosine therapy for 13 years, however, stopped 4 years before the onset of visual symptoms. No alteration of therapy was offered to patient 2 as didanosine therapy was interrupted 9 years previously. Since 2011, 11 cases of ritonavir maculopathy have been reported in the literature. Relentless worsening of vision was reported in 3/7 patients despite cessation of ritonavir therapy. Didonasine peripheral retinopathy was first described in 1992, and a total of 24 patients have been reported since. Relentlessly progressive peripheral retinopathy was diagnosed despite the previous cessation of therapy in 14 patients.Conclusion: Ritonavir causes a slowly progressive atrophic maculopathy, and didanosine toxicity results in a relentlessly progressing peripheral atrophic retinopathy. The relentless progression of both toxic retinopathies reflects permanent alterations of the retinal metabolism by these medications. Both ritonavir and didanosine toxic retinopathies are rare events, but their clinical presentation is highly specific.

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Ritonavir and bull’s eye maculopathy: case report

Cited by 4 publications

References 6 publications

Retinopathy Associated With Ritonavir Treatment for HIV Infection: A Case Series Reappraisal in the COVID-19 Era

Retinopathy Associated With Ritonavir Treatment for HIV Infection: A Case Series Reappraisal in the COVID-19 Era

Disease of the Year: Differential Diagnosis of Uveitic Macular Edema

Case Report: Multimodal Imaging of Toxic Retinopathies Related to Human Immunodeficiency Virus Antiretroviral Therapies: Maculopathy vs. Peripheral Retinopathy. Report of Two Cases and Review of the Literature

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