Retinal Nerve Fibre Layer, Macular and Choroidal Thickness in Erectile Dysfunction Patients on Sildenafil
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Abstract
Introduction: Sildenafil citrate is an effective treatment for erectile dysfunction (ED). Despite established safety profile, its long-term ocular implications remain unclear. We evaluate the relationship between the duration of use with retinal nerve fibre layer (RNFL), macular and choroidal thickness. Materials and methods: A cross-sectional study was done between July 2020 and June 2021, among 47 ED patients on sildenafil. The subjects fulfilling the inclusion criteria underwent optical coherent tomography (OCT) to evaluate RNFL, macular and choroidal thickness. Linear regression analysis was done to assess the relationship between duration of use with OCT parameters. Other possible associated factors were evaluated. Results: Forty-seven patients with the mean age of 54.30±8.41 years old recruited. These patients had not experienced visual disturbance on each sildenafil use. There were significant correlations between diabetes mellitus (DM) (r=0.330, P=0.023), erection hardness score (EHS) (r=-0.469, P=0.001) and total cumulative dose (r=0.806, P=<0.001) with duration of use. Duration of use had significant negative linear relationship with the average RFNL (b = -0.284, P=<0.001), superior RNFL (b = -0.195, P=0.018), and inferior RNFL (b = -0.887, P=<0.001). Multiple linear regression (MLR) reveals average RNFL was also influenced by total cumulative dose (b = -0.003, P = 0.029). No significant relationship observed to the macular thickness. Significant linear relationship observed between duration of use with sub-foveal choroidal thickness (b = 0.640, P<0.001). Conclusion: Sildenafil in general does not cause visual symptoms, however subclinical ocular changes; RNFL thinning and choroidal thickening may be influenced by its duration of use. Long term ocular monitoring is recommended.
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