tacrolimus and Blindness

Tacrolimus is associated with optic neuropathy. The clinical features of tacrolimus-induced optic neuropathy (TION) are unclear. The purpose of this article is to explore the clinical features of TION.. TION-related case reports were collected and analysed by searching Chinese and English databases from 1989 to 31 December 2021.. Twelve males and 7 females were included, with a median age of 54 years (range 23-66). TION onset time ranged from 2 months to 16 years after administration, and the main clinical features were blurred vision (4 cases), decreased visual acuity (7 cases), decreased visual acuity (5 cases), grey films (3 cases), visual field damage (3 cases) and headache (2 cases). Fifteen patients developed bilateral optic neuropathy. Ophthalmological examination showed visual acuity ranging from 20/25 to blindness, pupillary examination revealed relative afferent pupillary defect in 9 patients and marked decrease in colour vision in 15 eyes. The optic disc showed pallor (10 cases), oedema (8 cases), atrophy (4 cases) and haemorrhage (2 cases). After discontinuation or dose reduction of tacrolimus, symptoms improved in 10 patients, 1 patient recovered completely, and 4 patients did not recover.. TION presents diverse clinical manifestations. TION should be promptly identified and treated to prevent severe and permanent vision loss.

Topics: Adult; Aged; Blindness; Female; Humans; Male; Middle Aged; Optic Nerve Diseases; Tacrolimus; Visual Acuity; Visual Fields; Young Adult

Topics: Adolescent; Blindness; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Peripheral Vascular Diseases; Retinal Diseases; Tacrolimus

Tacrolimus has been associated with several ocular adverse effects, such as optic neuropathy.. A 56-year-old woman noted sudden, severe, painless visual loss in her left eye. She had undergone liver transplantation for alcoholic related cirrhosis 6 months before. Her chronic immunosuppressive regimen consisted of prednisone and tacrolimus at dosage of 1.5 mg orally once daily. Consequently, the patient developed a left optic neuropathy.. We report the first case of unilateral optic neuropathy associated with oral tacrolimus medication. Surgeons and ophthalmologists must evaluate ocular symptoms in the post-transplantation period, and suspicion should be maintained even if unilaterality or asymmetry of symptoms against a toxic etiology.

Topics: Blindness; Female; Humans; Immunosuppressive Agents; Liver Transplantation; Middle Aged; Optic Nerve Diseases; Tacrolimus; Tomography, Optical Coherence

Posterior reversible encephalopathy syndrome (PRES) is a condition characterized by reversible symptoms including headache, visual disturbances, focal neurological deficits, altered mentation, and seizures. It has been associated with circumstances that may affect the cerebrovascular system, such as hypertension, eclampsia, and immunosuppression with calcineurin inhibitors. The underlying etiology of PRES has remained unclear; however, cerebrovascular autoregulatory dysfunction, hyperperfusion, and endothelial activation have been implicated.. We describe a case of a young patient with lung transplant, who presented with headache, acute binocular blindness, and seizure immediately after infusion of saline through a peripherally inserted central catheter line, which inadvertently terminated cephalad in the left internal jugular vein, near the jugular foramen. Subsequent brain magnetic resonance imaging revealed vasogenic edematous lesions in a pattern consistent with PRES--a diagnosis supported by his constellation of symptoms, history of lung transplantation on tacrolimus immunosuppression, and relative hypertension.. This is the first reported case describing the development of PRES after the insertion of a peripherally inserted central catheter line. The development of PRES in a typical high-risk patient immediately after cerebral venous outflow obstruction implicates the role of the cerebral venous system and provides potential insight into the mechanism of this disorder that remains of unclear pathogenesis.

Topics: Adult; Blindness; Brain; Catheterization, Central Venous; Headache; Humans; Hypertension; Immunosuppression Therapy; Lung Transplantation; Magnetic Resonance Imaging; Male; Posterior Leukoencephalopathy Syndrome; Seizures; Tacrolimus; Treatment Outcome

Tacrolimus (FK506) has recently been approved for immunosuppression in organ transplantation, although its use is accompanied by a wide spectrum of neurotoxic side effects. We describe the clinical, radiological, and pathological features of 3 cases of tacrolimus-related leukoencephalopathy. The syndrome of immunosuppression-related leukoencephalopathy is proposed as an uncommon neurological syndrome occurring in patients with organ transplants involving demyelination, in particular in the parieto-occipital region and centrum semiovale. Although the syndrome is not associated with a particular (absolute) serum level of tacrolimus, it resolves spontaneously upon decreasing the dose. The tacrolimus-related syndrome has a similar radiographic and pathologic appearance as the analogous syndrome that occurs in patients taking cyclosporine.

Topics: Adult; Blindness; Dose-Response Relationship, Drug; Female; Graft Rejection; Humans; Immunosuppressive Agents; Leukoencephalopathy, Progressive Multifocal; Liver Transplantation; Magnetic Resonance Imaging; Male; Middle Aged; Occipital Lobe; Parietal Lobe; Remission, Spontaneous; Tacrolimus; Tomography, X-Ray Computed

Three patients who developed acute onset of cerebral blindness within 5-47 days of BMT using tacrolimus (FK506) as primary GVHD prophylaxis are described. This syndrome has been described with the use of cyclosporin A (CsA) and FK506 in solid organ transplant recipients. CsA-induced cerebral blindness has also been noted in BMT recipients but to date there have been no reports of this complication in BMT patients receiving FK506. We have noted a striking similarity in the clinical and radiographic presentations between these patients and those with CsA-associated cerebral blindness. Reversibility within 1-2 weeks of onset and the potential for substitution of CsA for FK506 in these patients is described.

Topics: Adult; Blindness; Bone Marrow Transplantation; Brain; Cyclosporine; Female; Humans; Immunosuppressive Agents; Magnetic Resonance Imaging; Male; Tacrolimus

Topics: Adult; Blindness; Brain Diseases; Cerebral Cortex; Female; Humans; Liver Transplantation; Magnetic Resonance Imaging; Tacrolimus