97th DOG Annual Meeting 1999



S. Walter1, H. Bertz2, J. Gerling1

Cyclosporin A (CsA) is widely used as prophylaxis and treatment of graft versus host disease after bone marrow transplantation. Optic neuropathy as a possible side effect of CsA in bone marrow patients is so far not routinely considered.

Case report: A 52 year old male presented with visual decline on both eyes 6 months after allogenic bone marrow transplantation and under CsA. Bone marrow was transplanted because of chronic myeloid leukemia. The optic nerve head was bilaterally swollen and showed peripapillary hemorrhages and cotton-wool spots. At the time of visual deterioration the patient was on Cyclosporin A and prednisolone 10 mg/day. CsA serum levels were within the therapeutic range (150-300 ng/ml). Possible causes for bilateral optic disc swelling were ruled out including normal MRI and normal liquor results. A side effect of the CsA was considered and the medication stopped. In addition, prednisolone dose was increased to 250 mg twice a day. Within 20 days after cessation of CsA visual acuity increased on the right eye from 1/35 to 0.5 and on the left eye from 0.7 to 1.0. Scotoma of the visual fields improved in the same time interval. Over a period of 8 months the bilateral swelling of the optic disc decreased but partial optic atrophy with permanent visual impairment remained.

Discussion: Bilateral optic disc swelling with visual decline under Cyclosporin A and improvement of visual function after cessation of the medication strongly suggests a drug induced optic neuropathy. In cases published so far the possible role of increased intracranial pressure and toxic serum levels of CsA was discussed but these were not found in our patient. A side effect of CsA causing optic neuropathy in patients after bone marrow transplantation should be considered.

1Universitäts-Augenklinik, Killianstr. 5, D-79106 Freiburg
2Medizinische Universitätsklinik I, Hugstetter Str. 55, D-79106 Freiburg