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Título

The effects of phosphodiesterase inhibitors type 5 on ophthalmological and psychophysical parameters in males with Erectile Dysfunction

Resumo

INTRODUCTION: Phosphodiesterase Inhibitors (PDI) play significant roles in penile erection physiology, inhibiting PDE type-5 in the smooth muscle of the sinusoids of the corpus cavernosum. Nevertheless, a minority of patients undergoing treatment for erectile dysfunction (ED) with PDE5i have related unfavorable visual occurrences, encompassing Arterial Ischemic Optic Neuropathy. This phenomenon arises due to the concurrent inhibition of PDE type 6, exclusively found within the retinal structure. OBJECTIVE: We aim to evaluate the ophthalmologic changes in men with a recent diagnosis of ED before and after a dose of tadalafil 20mg. METHODS: We assess a cohort of men aged 33-59 without previous ophthalmological surgical intervention. We excluded men with diabetes and uncontrolled systemic arterial hypertension. The following parameters were analyzed before and after 12 hours of 20 mg tadalafil administration: visual adverse effects, arterial blood pressure, cardiac frequency, bilateral intraocular pressure (IOP), and visual acuity. We performed the Fansworth-Munsell D15 color discrimination, the Lantony D15 test, and optic coherence tomography (OCT) to evaluate the retinal layer thickness. Data analysis was performed using SPSS 22.0. P was set at 0.05. RESULTS: Visual adverse effects were reported in 19% of 30 men (mean age 49.4±6.7). There was a reduction in IOP (P=0.023), and the reduction in diastolic arterial blood pressure after the medication was statistically significant (P =0.004). OCT data showed significant differences in the left eye's internal and external upper quadrants (respectively, P=0.023 and P=0.038). Four of the six patients experiencing visual symptoms exhibited increased thickness in the macula, especially on the Foveal Minimum (FM), with a 2.48% increase (p=0.020), and the fovea, with a 1.17% increase (p=0.017). The Color Confusion Index (CCI), the Confusion-Index (C-Index), and the Selectivity Index of saturated colors (S-Index) decreased after the tadalafil administration. However, the differences were only significant in the right eye-CCI (P =0.012) and right eye-C-Index (P=0.027). The Lantony D15 test revealed a statistical difference in the left eye-C-Index (P=0.048). CONCLUSIONS: The study confirmed that tadalafil has adverse effects, including decreased diastolic pressure and discrete visual changes. However, it is ocularly safe due to its low specificity for PDE-6, which is almost exclusively found in the retina.

Palavras Chave

Ophthalmic Changes; erectile dysfunction; Tadalafil