Poppers Maculopathy: Complete Restitution of Macular Changes in OCT after Drug Abstinence.
BACKGROUND
"Poppers" is a slang term for a group of alkyl nitrites that are used as recreational drugs. Their inhalative intoxication leads to muscle relaxation, analgesia, and euphoria. Maculopathy is a rare but serious side-effect.


METHODS
Clinical, imaging, and electrophysiological findings of seven patients with maculopathy after consumption of poppers were presented.


RESULTS
All seven patients were male with a median age of 35 years (range 28-45 years), the median duration of periodical poppers use until the onset of symptoms was 9.8 years (one day to 25 years). Five of seven patients were HIV-positive, one patient was negative, and the HIV-status of one patient was unknown. Median average of visual acuity at presentation was 20/30 in each eye. In all patients, optical coherence tomography (OCT) showed pathognomonic alterations of the outer foveal retina. One patient showed an almost complete restitution of the maculopathy six months after cessation of drug use and following the oral intake of Lutein. Imaging alterations returned to normal and visual acuity recovered from 20/50 and 20/30 (right and left eye, respectively) to 20/20 on both eyes. Follow up of two other cases showed no relevant functional decline or improvement.


CONCLUSIONS
Toxic maculopathy due to the consumption of poppers is an important differential diagnosis in acute visual loss without clinico-morphological correlate. Optical coherence tomography is the only reliable diagnostic tool in these cases. Complete recovery of visual function and macular morphology is rare, even after cessation of drug abuse. Oral lutein therapy may have a beneficial effect.
a Department of Ophthalmology , Charité-Universitätsmedizin Berlin , Germany.
Milena
M
Pahlitzsch
a Department of Ophthalmology , Charité-Universitätsmedizin Berlin , Germany.
Christian
C
Mai
a Department of Ophthalmology , Charité-Universitätsmedizin Berlin , Germany.
Antonia M
AM
Joussen
a Department of Ophthalmology , Charité-Universitätsmedizin Berlin , Germany.
Richard
R
Bergholz
D000328:Adult; D015658:HIV Infections / Q000150:complications; D006801:Humans; D013287:Illicit Drugs / Q000633:toxicity*; D014975:Lutein / Q000008:administration & dosage; D008266:Macula Lutea / Q000187:drug effects* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D061848:Optical Imaging; D012164:Retinal Diseases / Q000139:chemically induced / Q000175:diagnosis / Q000503:physiopathology*; D012189:Retrospective Studies; D015813:Substance Abuse Detection; D013375:Substance Withdrawal Syndrome / Q000503:physiopathology*; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology
D013287:Illicit Drugs; D014975:Lutein
Alkyl nitrites; lutein therapy OCT; poppers maculopathy; toxic maculopathy