실데나필 시트르산염 과다복용 후 발생한 색각이상 및 시야감소 1예

A Case of Transient Color Anomaly and Persistent Visual Field Defect after Sildenafil Citrate Overdose

목적: Sildenafil citrate는 선택적으로 phosphodiesterase type 5 (PDE5)를 억제하여 발기를 지속시키는 경구용 발기부전 치료제로 널리 사용되는 약제이다. 본 저자는 sildenafil citrate 과다복용 이후에 발생한 색각이상 및 시야감소 1예를 보고하고자 한다. 증례요약: 특이 전신 질환이 없던 39세 여자 환자가 내원 3일 전 자살 목적으로 sildenafil citrate 50 mg 30알을 복용 후 시작된 시야감소를 주소로 내원하였다. 교정시력 우안(1.0), 좌안(1.0)이었으며 빛간섭단층촬영 및 안저검사상 특이소견은 발견되지 않았으나, 색각이상 및 시야검사에서 중심 암점이 관찰되었다. 경과관찰 5주간 시력변화는 없었으며 색각이상은 소실되었으나, 시야는 호전되는양상이지만 결손은 남아있었다. 결론: Sildenafil의 추천용량을 넘어서는 고용량을 한 번에 복용할 경우 일시적인 색각이상과 지속되는 중심 암점과 같은 시기능 저하가 나타날 수 있다.

Purpose: Sildenafil citrate, is an oral tablet demonstrating efficacy for maintaining an erection in males with erectile dysfunction by inhibiting phosphodiesterase type 5 (PDE5). In the present study, we report 1 case of a transient color anomaly with visual field defect after an overdose of sildenafil citrate. Case summary: One patient, a 39-year-old female, with no significant medical history other than previous major depressive disorder,visited an outpatient department due to the visual field defect that began after taking 30 tablets of sildenafil citrate (50 mg)3 days earlier. A number of ophthalmologic tests were administered including visual acuity test, color vision test, fundus photography and the measurement of retinal structure with optical coherent tomography and her condition was monitored. The best corrected visual acuity was 1.0 in both right and left eyes in her first visit. The color anomaly and a central scotoma of both eyes were detected in the visual field test, while significant signs were not observed after evaluation using optical coherent tomography and fundus photography. After 5 weeks, the visual acuity was not affected, the color anomaly symptom disappeared and the focal visual field defect was present although improved. Conclusions: Transient color anomaly and persistent central scotoma caused by an overdose ingestion of sildenafil has not been reported in Korea, The related mechanisms may involve the inhibition of PDE5 on ganglion cells and bipolar cells in the retina and interruption of phosphodiesterase type 6 (PDE6) function in both rods and cones.