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Case Report/Case Series |

Acute, Bilateral, Concurrent Central Retinal Artery Occlusion in Sickle Cell Disease After Use of Tadalafil (Cialis)

Ravi K. Murthy, MD1; Lizette Perez, MD1; Joshua C. Priluck, MD1; Sandeep Grover, MD1; Kakarla V. Chalam, MD, PhD1
[+] Author Affiliations
1Department of Ophthalmology, University of Florida College of Medicine, Jacksonville
JAMA Ophthalmol. 2013;131(11):1471-1473. doi:10.1001/jamaophthalmol.2013.5047.
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Importance  Sickle cell disease (SCD) is characterized by vaso-occlusive crisis. In the eye, central retinal artery occlusion (CRAO) is a rare complication in SCD, with only 1 previous report of bilateral, concurrent CRAO. We report a case of bilateral, concurrent CRAO in a patient with SCD, possibly precipitated by the use of phosphodiesterase 5 inhibitors.

Observations  A 37-year-old African American woman with a known medical history significant for SCD and pulmonary arterial hypertension who was receiving treatment with tadalafil, a phosphodiesterase 5 inhibitor, developed bilateral, concurrent CRAO that persisted after exchange transfusion.

Conclusions and Relevance  Bilateral CRAO secondary to SCD is extremely rare, with only 1 previous case report in the literature. The use of phosphodiesterase 5 inhibitors is an additional risk factor and may have contributed to the development of concurrent CRAO in this patient.

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Figure 1.
Color Fundus Photographs

Color fundus photographs of the right (A) and left (B) eyes of a patient with acute, bilateral, concurrent central retinal artery occlusion revealing attenuated arterioles and a cherry-red spot at the macula of each eye.

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Figure 2.
Fundus Fluorescein Angiograms

Fundus fluorescein angiograms (left) with concurrent spectral-domain optical coherence tomography (SD-OCT) scans (right) of the right (A) and left (B) eyes revealing ischemic fovea with inner macular thickening on SD-OCT. Green arrows originate at the area seen in each SD-OCT scan.

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