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Value of fundus autofluorescence imaging in a rare case of clonazepam associated retinopathy
Author(s) -
MATEO J,
JIMENEZ B,
ASCASO F,
MATEO A,
PEREZ D,
CASAS P
Publication year - 2012
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2012.s076.x
Subject(s) - medicine , clonazepam , ophthalmology , blurred vision , retina , fluorescein angiography , fundus (uterus) , retinopathy , visual acuity , anesthesia , psychology , neuroscience , endocrinology , diabetes mellitus
Purpose Many unwanted ocular effects have been described after the ingestion of psychotropic drugs. Clonazepam is an anticonvulsant and anxiolytic agent belonging to the family of benzodiazepines. Our aim is to report a case of toxic retinopathy associated with prolonged administration of clonazepam. Methods We present a case of a middle‐aged woman, with no significant ocular or familial ocular history, who complained of bilateral blurred vision and photophobia. She had a long‐lasting anxiety disorder and underwent clonazepam for the previous 8 years. We carried out a complete ophthalmological examination including visual acuity and color vision testing, funduscopy, fluorescein angiography, electrophysiologic retinal testing, optical coherence tomography and fundus autofluorescence (FAF). We found multiple retinal mild depigmentation dots in the posterior pole of both eyes that showed a clear hyperautofluorescence and slightly reduced electrophysiologic responses. Other possible diagnoses were ruled out as multiple evanescent white dot syndrome or macular dystrophy associated with hyperautofluorescence. Results A large variety of drugs may have toxic effects on the human retina. Thus, retinopathy has been shown to be related to high doses of typical antipsychotics, mainly chlorpromazine and thioridazine, but only two cases of retinal toxicity by benzodiazepines have been described. To our knowledge, this is the first reported case of FAF imaging findings in a retinopathy associated with clonazepam. Conclusion Neurologists and ophthalmologists should be aware of the possible retinal toxicity of clonazepam and FAF should be considered as a complementary imaging modality in the diagnosis of toxic or drug‐induced retinopathy.