K 335
Amiodarone (Cordarex®) induced Opticusneuropathy: A case report
K. Weber, R. Tesnau, M. M. Danielczyk, R. Welt
Background: A 49-year-old woman was referred to our outpatient department. She complained of rapidly decreasing lost of visual acuity in the left eye (best corrected visual acuity 0,12 OS, oculus melior). The right eye has known amblyopia since childhood. Our clinical examination showed myopia permagna, strabismus alternans and a total scotoma in the perimetry (Humphrey, 81 points). In fundus examination a myopic maculopathy , an unremarkable disc of the optic nerve were observed. The fluorescein angiography was also unremarkable. In the patient history there was found a two year drug-history of Amiodarone (Cordarex®).
Methods: A pattern VEP with best corrected visus acuity, 0.9 Hz, 99 % contrast, full field and a pattern size of 7,5 and 3,75 deg was monocular performed.
Results: Even if - due to the amblyopia of the RA - the patient herself just noticed the visual acuity of the left eye (oculus melior), on both eyes the P100 latencies indicated pathological changes. Cornea verticillata as well as the increased latencies and characteristic amplitudes of P100 in the pattern VEP lead to the diagnosis of an opticusneuropathy. After having stopped the treatment with Cordarex® in agreement with the cardiologist, both, the visual acuity (OS 0,25) and the perimetry improved. Instead of these clinical features the P100 latencies in pattern VEP still remained increased after an one and three months period.
Conclusion: In literature an Amiodarone induced peripheral neuro-myopathy with electrophysiological changed and polyphasical reduced amplitudes has been described. Although in a three months follow-up the clinical findings slowly were reported to be improved, only a delayed reversibility of the toxic optic neuropathy (evaluation of the pattern VEP) could be observed.
Augenklinik des Klinikums der Stadt Ludwigshafen am Rhein, Bremserstraße 79, D 67063 Ludwigshafen