Tacrolimus
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Bilateral ischaemic optic neuropathy: case report A 54-year-old man developed bilateral optic neuropathy during treatment with tacrolimus. The man presented with a painless decrease in vision in his left eye. He had undergone liver transplant 6 months earlier and had been receiving oral tacrolimus 2.5mg two times daily, mycophenolate and prednisolone, to maintain immunosuppression for 5 months. His best corrected visual acuity was 20/20 and 20/400, OD and OS respectively, and a relative afferent pupillary defect was observed in his left eye. A cecocentral scotoma with an inferior predilection and a delayed P100 latency were also observed in his left eye. At the time, his tacrolimus concentration was 6.2 mg/L. Idiopathic ischaemic optic neuropathy was suspected and regular follow-up was planned. Three months later, visual acuity had decreased in both eyes to counting fingers. Temporal pallor of the optic disc was observed in his left eye, and both eyes showed cecocentral scotomata with inferior predilection. In both eyes, fluorescein angiography showed no florescence filling in the optic disc; ischaemic optic neuropathy associated with tacrolimus was suspected, and it was recommended to withdraw tacrolimus. At this time, the man developed a mild increase in his liver enzymes and chronic rejection was suspected. Tacrolimus was immediately withdrawn, and he began ciclosporin for immunosuppression. After 2 weeks, his visual acuity had improved to 20/60 OD but was still limited to counting fingers OS. One month after discontinuing tacrolimus, his visual acuity was 20/50 OD and stationary OS. The visual field in his right eye had improved but was stationary in his left eye. Fluorescein angiography showed no fluorescence filling in the optic disc of either eye. Author comment: "In this study, absolutely no blood flow to the optic disc was evident according to the [fluorescein angiography] results, suggesting that tacrolimus-induced ischemia might be one of the mechanisms of optic neuropathy." Yun J, et al. Bilateral ischemic optic neuropathy in a patient using tacrolimus (FK506) after liver transplantation. Transplantation 89: 1541-1542, No. 12, 27 Jun 2010. Available from: URL: http://dx.doi.org/10.1097/tp.0b013e3181d2fe83 803031424 South Korea
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Reactions 14 Aug 2010 No. 1314
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