Intracoital subfoveal hemorrhage after tadalafil (cialis) premedication: A case report

Tommaso Rossi, Barbara Boccassini, Luca Placentino, Mario Iossa, Maria Giulia Mutolo, Ciro Tamburrelli

Research output: Contribution to journalArticle

Abstract

Purpose: The purpose of this study is to report the first case, to our knowledge, of intracoital subfoveal hemorrhage occurring 1 hour after tadalafil premedication in a patient with previously undiagnosed retinal angiomatous proliferation and erectile dysfunction. Methods: This is an interventional case report. The patient underwent Snellen vision acuity measurement, anterior and posterior segment biomicroscopy, and indirect ophthalmoscopy. Optical coherence tomography, fluorescein angiography, and indocyanine green angiography were also performed as needed. Recombinant tissue plasminogen activator 100 μg/0.1 mL and 0.3 mL pure SF6 gas were injected in the vitreous on presentation. Four days later, the patient received 1.25 mg/0.1 mL of intravitreal bevacizumab. Results: One day after recombinant tissue plasminogen activator and gas injection, visual acuity rose to 20/60-2. A week later, visual acuity was unchanged, and the subretinal hemorrhage displaced from the foveola. Optical coherence tomography showed a marked regression of submacular thickening. Conclusion: Despite strict time correlation, the submacular hemorrhage cannot be unequivocally attributed to tadalafil assumption because many other risk factors are to be considered: the Valsalva maneuver above all. Nonetheless, a suspicion should be raised, at least as a cofactor, given the drug mechanism of action and the report of vascular abnormalities bleeding in the literature, including cerebral arterovenous malformation and epistaxis. Caution should be exercised in the prescription of phosphodiesterase type 5 inhibitors to patients with known vascular abnormalities including retinal and choroidal abnormalities: retinal angiomatous proliferation, classic and occult neovascularization of any origin, and also, possibly, hemangioma.

Original languageEnglish
Pages (from-to)377-380
Number of pages4
JournalRetinal Cases and Brief Reports
Volume4
Issue number4
DOIs
Publication statusPublished - Sep 2010

Keywords

  • Choroidal neovascularization
  • Phosphodiesterase type 5 inhibitors
  • Retinal angiomatous proliferation
  • Subfoveal hemorrhage
  • Subretinal bleeding
  • Tadalafil.

ASJC Scopus subject areas

  • Ophthalmology

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  • Cite this

    Rossi, T., Boccassini, B., Placentino, L., Iossa, M., Mutolo, M. G., & Tamburrelli, C. (2010). Intracoital subfoveal hemorrhage after tadalafil (cialis) premedication: A case report. Retinal Cases and Brief Reports, 4(4), 377-380. https://doi.org/10.1097/ICB.0b013e3181babef2