Publication: Evaluation of retinal nerve fiber layerthickness, macular thickness andchoroidal thickness in erectile dysfunction patients on sildenafil
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Date
2022
Authors
Nordin, Mohammad Hudzaifah
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Abstract
Introduction Sildenafil citrate is a potent selective inhibitor of cyclic guanosine monophosphate (cGMP)- specific phosphodiesterase type 5 (PDE5) enzymes, which enhances nitric oxide (NO)- mediated erection. At the ocular level, it has a tenfold less potent inhibitory activity against the cGMP dependent PDE6 enzyme which is abundant in the retina. Despite the established safety profile, multiple reports had been published associating sildenafil to ocular injury. Some studies about the retinal nerve fiber layer (RNFL), macula and choroids are also conflicting. Still, sildenafil-dependent-men may be at risk of getting blinding ocular events throughout their duration of use. Although acute dose related toxicity effect has been established, implication of long-term regular use of sildenafil and total cumulative sildenafil dose effects are still somewhat unclear. We evaluate the relationship between duration of sildenafil use to the RNFL, macular and choroidal thickness. Methods A hospital based cross-sectional study was done among 47 erectile dysfunction (ED) patients on sildenafil in Hospital Universiti Sains Malaysia between July 2020 and June 2021. The subjects fulfilled the inclusion criteria with normal ocular examinations underwent optical coherent tomography (OCT) examination to evaluate RNFL, macular and choroidal thickness. Linear regression analysis was done to evaluate the relationship between duration of use with the OCT parameters. Other possible associated factors were also evaluated. Results Forty-seven ED patients with the mean age of 54.30±8.41 years old recruited (ranging 41 to 71). The patients did not complain any visual disturbance on each sildenafil use. Majority had erectile hardness score (EHS) of 2 (penis is hard but not hard enough for penetration) (93.6%). There was significant correlation between diabetes mellitus (DM) (r=0.330, P=0.023), EHS (r=-0.469, P=0.001) and total cumulative dose (r=0.806, P=<0.001) with the duration of use. Duration of use had significant linear relationship with the average RFNL (b = -0.284, P=<0.001), superior RNFL (b = -0.195, P=0.018), and inferior RNFL (b = -0.887, P=<0.001) revealing reduced RNFL thickness with increased duration of use. Multiple linear regression (MLR) reveals average RNFL was also influenced by total cumulative dose (b = -0.003, P = 0.029). No significant relationship between duration of use and other variables are observed to the macular thickness. Significant linear relationship was observed between duration of use with sub-foveal choroidal thickness (b = 0.640, P<0.001). Conclusions Sildenafil in general does not cause visual symptoms, however subclinical ocular changes; RNFL thinning and choroidal thickening may be influenced by its duration of use. Long term ocular monitoring of sildenafil-dependent ED patients is recommended.
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