Skip to main content

Advertisement

SpringerLink
Log in

Electrophysiological features and multimodal imaging in ritonavir-related maculopathy

  • Clinical Case Report
  • Published:
Documenta Ophthalmologica Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study is to report a case of ritonavir-related retinal toxicity followed over a year. Electrophysiological features and multimodal imaging, including adaptive optics, are provided and discussed.

Methods

Electrophysiological recordings and multimodal imaging were performed and repeated over 1 year.

Results

Fundus examination revealed crystalline maculopathy in conjunction with pigment disruption. Spectral domain optical coherence tomography displayed thinning of the macula without cysts. Autofluorescence imaging revealed a mixed pattern of complete loss of the autofluorescence in the area of retinal pigment deposit and an increased transmission of the autofluorescence in the area of retinal thinning. Fluorescein angiography ruled out parafoveal telangiectasia. Indocyanine green angiography was not contributive. Increased spacing of the macular cone mosaic, crystal deposits and pigment migrations were seen with adaptive optics. Full-field electroretinogram was slightly reduced for both eyes, especially in the light-adapted responses, and mfERG confirmed bilateral maculopathy. Functional and structural abnormalities did not change with follow-up besides constant pigmentary changes monitored with adaptive optics.

Conclusion

Ritonavir-related retinal toxicity is a maculopathy with peculiar features including crystalline and pigment migration associated with central or temporofoveolar thinning and inconstant macular telangiectasia. Despite drug cessation, retinal remodelling continues to progress.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

References

  1. Roe RH, Jumper JM, Gualino V, Wender J, McDonald HR, Johnson RN, Fu AD, Cunningham ET Jr (2011) Retinal pigment epitheliopathy, macular telangiectasis, and intraretinal crystal deposits in HIV-positive patients receiving ritonavir. Retina 31:559–565

    Article  PubMed  Google Scholar 

  2. Leiner S (2012) Re: retinal pigment epitheliopathy, macular telangiectasis, and intraretinal crystal deposits in HIV-positive patients receiving ritonavir. Retina 32(2):411

    Article  PubMed  Google Scholar 

  3. European Medicines Agency. Scientific discussion for the approval of Norvir. http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_Scientific_Discussion/human/000127/WC500028725.pdf

  4. McCulloch DL, Marmor MF, Brigell MG, Hamilton R, Holder GE, Tzekov R, Bach M (2015) ISCEV Standard for full-field clinical electroretinography (2015 update). Doc Ophthalmol 130(1):1–12

    Article  PubMed  Google Scholar 

  5. Biancardi AL, Curi ALL (2016) Retinal toxicity related to long-term use of ritonavir. Retina 36:229–231

    Article  PubMed  Google Scholar 

  6. Anderson N, Borlak J (2006) Drug-induced phospholipidosis. FEBS Lett 580(23):5533–5540

    Article  CAS  PubMed  Google Scholar 

  7. Gocho K, Sarda V, Falah S, Sahel JA, Sennlaub F, Benchaboune M, Ullern M, Paques M (2013) Adaptive optics imaging of geographic atrophy. Invest Ophthalmol Vis Sci 54:3673–3680

    Article  PubMed  Google Scholar 

  8. Fawzi AA, Lee NG, Eliott D, Song J, Stewart JM (2009) Retinal findings in patients with Alport Syndrome: expanding the clinical spectrum. Br J Ophthalmol 93(12):1606–1611

    Article  CAS  PubMed  Google Scholar 

  9. Vadlapatla RK, Vadlapudi AD, Pal D, Mukherji M, Mitra AK (2014) Ritonavir inhibits HIF-1α-mediated VEGF expression in retinal pigment epithelial cells in vitro. Eye (Lond) 28(1):93–101

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Unité d’électrophysiologie, Centre hospitalier national d’ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75571, Paris, France

    Céline Faure & Isabelle Audo

  2. Ramsay Générale de santé, Hôpital Privé Saint Martin, 18, rue des Roquemonts, 14050, Caen, France

    Céline Faure

  3. INSERM U968, CNRS, UMR 7210, Institut de la Vision, Sorbonne Universités, UPMC Univ Paris 06, Paris, France

    Michel Paques & Isabelle Audo

  4. Département hospitalo-universitaire ViewMaintain, Inserm-Direction de l’hospitalisation et de l’organisation des soins-Centre d’Investigations cliniques (DHOS CIC) 1423, Centre hospitalier national d’ophtalmologie des Quinze-Vingts, 75012, Paris, France

    Michel Paques & Isabelle Audo

Authors
  1. Céline Faure
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michel Paques
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Isabelle Audo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Céline Faure.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human rights

All procedures performed in this study involving our human participant were in accordance with the ethical standards of the institutional and / or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Statement on the welfare of animals

This article does not contain any studies with animals performed by any of the authors.

Patient consent

The patient has consented to the submission of the manuscript for this journal.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Time-lapse AO movie showing the redistribution of melanosomes inside melanin-loaded cells (MP4 931 kb). The migration of th melanin pigments suggest a continuous process of remodelling of the scar tissue

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Faure, C., Paques, M. & Audo, I. Electrophysiological features and multimodal imaging in ritonavir-related maculopathy. Doc Ophthalmol 135, 241–248 (2017). https://doi.org/10.1007/s10633-017-9612-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10633-017-9612-z

Keywords

Search

Navigation