Tacrolimus induced optic neuropathy in post-lung transplant patients: A series of 3 patients

Abstract

Purpose Tacrolimus is a commonly used immunosuppressant medication after lung transplantation. In rare cases, tacrolimus causes a medication-induced optic neuropathy (TON) that can lead to significant vision loss. Observations In this series, we describe three cases of TON, 1–10 years after medication use. Two patients were young (22yr and 33yr) females with cystic fibrosis. The last case was a 65yr male with idiopathic pulmonary fibrosis. In 2/3 cases tacrolimus serum levels were normal. Visual acuity ranged from 20/20 to 20/300, and vision loss occurred acutely to sub-acutely, over a span of 2–3 months. Conclusions and importance As presented here, TON can be highly variable. MRI findings are often non-specific, from normal brain findings to extensive white matter changes. There remains an unclear association with graft-versus-host disease and reduced kidney function. Visual findings are often subtle, including color vision aberration and peripheral visual field deficits, both of which usually require an ophthalmologic evaluation. When diagnosed in a timely fashion, TON is at least partially reversible in up to half of all cases. While rare, the cases described here support post-lung transplant ophthalmologic evaluation in those taking high-risk medications.

Analysis of clinical features of tacrolimus‐induced optic neuropathy

“…Most patients present with bilateral optic neuropathy. Some patients develop unilateral optic neuropathy first and then affect the other optic nerve 9,20 . The appearance of the optic nerve can be normal, optic disc oedema (with or without perioptic haemorrhage) or pallor.…”

“…According to the inclusion and exclusion criteria, a total of 15 studies were included, [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] including 19 patients (12 males and 7 females) (Table 1). These patients were mainly from North America (10 cases), Europe (4 cases), Asia (4 cases) and South America (1 case), with a median age of 54 years (range .…”

“…Some patients develop unilateral optic neuropathy first and then affect the other optic nerve. 9,20 The appearance of the optic nerve can be normal, optic disc oedema (with or without perioptic haemorrhage) or pallor. MRI findings vary from normal brain to extensive white matter changes in different patients.…”