Fraunfelder FW, Fraunfelder FT (2008) Central serous chorioretinopathy associated with sildenafil.
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The distribution of age was normal among participants, according to Kolmogorov-Smirnov test. There were no differences in distribution of age between the groups (independent samples t-test: t(18)=-0.291, p=0.774, Levene's test: p=1.000). The mean values of choroidal thickness, as recorded in all three quadrants for each eye separately in group A before and after the consumption of sildenafil citrate are presented in Table 1 and Figures 2 and 3. The mean choroidal thickness in Group A was significantly increased in each quadrant after the intake of sildenafil (Table 2). Assessing each eye separately, significant raises in choroidal thickness were also noted in all areas (Table 3).
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Table 1: Choroidal thickness (CT) in all quadrants of the right (RE) and left (LE) eye, separately, in group A, before and after the consumption of sildenafil citrate. Table 2: Assessing the significance of increase in choroidal thickness (CT) in three quadrants, which is noted after each PDE-5 inhibitor intake within each group. Table 3: The significance of increase in choroidal thickness (CT), which follows the PDE-5 inhibitor administration, for each eye separately, between the two groups. The mean values of choroidal thickness for each eye separately in group B, before and after the consumption of tadalafil, are presented in Table 4 and Figures 5 and 6. The mean choroidal thickness in Group B was significantly increased in each quadrant after the intake of tadalafil (Table 2).
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Table 4: Choroidal thickness (CT) in all quadrants of the right (RE) and left (LE) eye, separately, in group B, before and after the consumption of tadalafil. Comparison of sildenafil and tadalafil effects on participants Assessing the mean choroidal thickness (CT) of the participants at baseline, no statistical significant differences were observed between the two groups (independent samples t-test, CT temporal: t(18)=-0.124, p=0.903, Levene's test: p=0.935, CT nasal: t(18)=0.511, p=0.616, Levene's test: p=0.473, Mann-Whitney test, CT inferior: p=0.912). Similarly, the mean choroidal thickness of each eye separately appeared no statistical significant differences between the two groups at baseline (Table 5). On the other hand, the mean choroidal thickness after the consumption of sildenafil or tadalafil was statistically different between the two groups (Mann-Whitney test, CT temporal: p=0.005, independent samples t-test, CT nasal: t(18)=2.647, p=0.016, Levene's test: p=0.321, CT inferior: t(18)=2.018, p=0.059, Levene's test: p=0.232). Statistically significant differences were also noted in the mean choroidal thickness of some quadrants for each eye separately, after the administration of the drugs (Table 5). Gordon-Bennett P, Rimmer T (2012) Central serous chorioretinopathy following oral tadalafil. Quiram P, Dumars S, Parwar B, Sarraf D (2005) Viagra-associated serous macular detachment.
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(2012) Optical coherence tomography in tadalafil-associated retinal toxicity.
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Both drugs may also be a potential useful adjunct to the treatment of ocular diseases that would benefit from increased choroidal blood flow. Both authors had full access to all the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. They have contributed in the conduct of the research as well as the analysis and interpretation of the data. Furthermore, they have participated in the writing of this manuscript and approved its final form. Finally, they have no conflict of interest to declare and no financial support was offered for the present manuscript.
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Shindel A, Brant WO, Bochinski D, Bella AJ, Lue TF (2014) Medical and Surgical Therapy of Erectile Dysfunction. Goldstein I, Lue TF, Padma-Nathan H, Rosen RC, Steers WD, et al. (1998) Oral sildenafil in the treatment of erectile dysfunction. Omori K, Kotera J (2007) Overview of PDEs and their regulation. Beavo JA (1995) Cyclic nucleotide phosphodiesterases: functional implications of multiple isoforms. Nichols DJ, Muirhead GJ, Harness JA (2002) Pharmacokinetics of sildenafil after single
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The increase in choroidal thickness observed after the intake of PDE-5 inhibitors was greater in group A and this difference exhibited statistical significance (independent samples t-test, CT temporal: t(18)=5.338, p<0.001, Levene's test: p=0.791, CT nasal: t(18)= 6.332, p<0.001, Levene's test: p=0.088, Mann-Whitney test, CT inferior: p<0.001). Table 5: Independent Samples Test for the mean choroidal thickness of each eye separately at baseline and after the consumption of sildenafil or tadalafil between the two groups. This increment was observed in mean choroidal thickness both of each participant and of each eye separately. Moreover, we highlighted that although there were no statistically significant differences in participants' means of choroidal thickness at baseline, the increase of the latter was greater in the group of sildenafil (increase in group A: temporal=9.8%, nasal=10.4%, inferior: 11.0%, increase in group B: temporal=4.3%, nasal=5.6%, inferior: 4.9%). noted raised choroidal buy cialis with priligy online perfusion and thickness in seven healthy male subjects two hours after ingesting 50mg of sildenafil.
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measured the choroidal thickness, based on EDI-OCT, in 8 healthy subjects (4 men and 4 women) 1 and 3 hours after the ingestion of 100 mg of sildenafil citrate and they identified its elevation [16]. noted that although sildenafil increases systolic and diastolic systemic arterial blood pressures, it had no effect on central retinal artery circulation, even in subjects with ocular side-effects [17]. The ocular symptoms caused by sildenafil were associated with the alterations in choroidal perfusion and the inhibition of PDE6 [17]. The latter inhibition seemed to be dose- and time-dependent [18]. Features such as painful red eye, subretinal and intratumoral hemorrhages, and intratumoral vascular congestion, detected in a patient with a malignant melanoma of the ciliary body and choroid, after receiving a single tadalafil tablet indicated the vasodilator effect of the latter on the eye [19].
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Moreover, tadalafil has been implicated in the development of concurrent central retinal artery occlusion (CRAO) in patients with additional risk factors, such as sickle cell disease [20]. In our study, choroidal thickness after tadalafil intake was measured for the first time in literature. Indeed, we found that tadalafil caused a lower increase of choroidal thickness in all quadrants compared to sildenafil. observed that sildenafil activated the synthase of nitric oxide (NO), via extracellular signal-regulated kinase (ERK) signaling, resulting in NO production and guanylyl cyclase activation [21]. The following accumulation of cGMP within vascular smooth muscles elicited the opening of the selective adenosine triphosphate (ATP)- sensitive potassium (KATP) channels in some types of vasculatures [21]. oral doses in healthy male subjects: absolute bioavailability, food effects and dose proportionality.
| Step | Description | Notes |
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| Take dose as directed | 1 tablet per day or as prescribed | Follow medical advice |
| Time to effect | 30-60 minutes after ingestion | Varies individually |
| Duration of effect | Up to 36 hours | Longer-lasting than some alternatives |
| Avoid alcohol | Alcohol can decrease effectiveness and increase side effects | Limit intake during use |
Margolis R, Spaide RF (2009) A pilot study of enhanced
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depth imaging optical coherence tomography of the choroid in normal eyes.
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This cascade was implicated in the inhibition of transmembrane influx of calcium through voltage-gated calcium channels due to membrane hyperpolarization, leading to vasorelaxation [21]. Moreover, they highlighted that the clinical doses of sildenafil did not cause potent vasodilation in retinal arterioles, but sildenafil seemed to have a significant impact on retinal perfusion [21]. They observed that 10 ng/mL of sildenafil were the threshold concentration for the dilation of retinal arterioles, whereas, even in the highest concentration (1 μg/ mL), the elicited dilation reached the 30% of the maximum [21]. Furthermore, sildenafil has been associated with alterations in retinal function. recorded depressed but normal full-field and multifocal cone ERGs in macula and periphery after the administration of 200 mg sildenafil [22].
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Prolonged implicit times of rod (maximum response a-wave) and cone (oscillatory potentials, cone response b-wave, 30 Hz-flicker and 3.3 Hz-flicker a-wave and b-wave) ERG responses in subjects receiving a single 100 mg dose of sildenafil were also recorded by Jägle et al. Similarly, two more studies supported a higher rod sensitivity (decrease in K) and response to light stimuli, as recorded by ERG 1 and 2 hours after ingesting 50 and 100 mg of oral sildenafil, respectively [24,25]. The anatomical and functional effects of sildenafil seem to be attributed to its high affinity with melanin [12]. The prolonged accumulation of sildenafil in the cialis 5 mg tablet retina and the potent inhibition of PDE-6, compared to tadalafil, are possible related to the greater augmentation of choroidal thickness induced by the former. Besides, as it has already stated before, the fact that tadalafil is 700-fold more potent for PDE5 than PDE6 eliminates its visual adverse effects.
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In summary, we concluded that both sildenafil and tadalafil raised choroidal thickness two hours after their consumption by healthy individuals. Moreover, the former induced greater increment in choroidal thickness, maybe due to its higher affinity with PDE5 compared to PDE6. This the first study in literature which compares both drugs in healthy individuals. This the first time in literature that the effect of tadalafil on chorioretinal vascular permeability and choroidal thickness is investigated. Physicians who prescribe these medications should have in mind these alterations, which could secondary affect retinal function and explain previously reported clinical symptoms and pathologies, including idiopathic serous macular detachment and central serous chorioretinopathy. (2013) Measurement of choroidal perfusion and thickness following systemic sildenafil (Viagra(®) ).
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Vance SK, Imamura Y, Freund KB (2011) The effects of sildenafil citrate
- Comparisons are often made between Cialis (tadalafil) and Viagra (sildenafil).
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on choroidal thickness as determined by enhanced depth imaging optical coherence tomography.
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