UK clinicians describe case of poppers maculopathy

A patient whose symptoms persisted following cataract surgery was found to have maculopathy caused by the inhalation of recreational drugs

A doctor wearing white lab coat writing a prescription

Moorfields Eye Hospital clinicians have described their treatment of a patient who was found to have poppers maculopathy after his symptoms persisted following cataract surgery.

Writing in BMJ Case Reports, the clinicians described how a man in his late 50s presented to a routine optometry appointment with blurred vision and difficulty reading road signs when driving.

His unaided visual acuity had dropped over the course of a year from 6/6 to 6/12+3 bilaterally.

A further examination by the optometrist found bilateral cataracts and the patient was referred to a Moorfields Eye Hospital ophthalmologist for consideration of cataract surgery.

After an examination at Moorfields Eye Hospital, the patient had uncomplicated phacoemulsification surgery on his right eye one month later.

At an examination 10 days after surgery, the patient’s unaided visual acuity was 6/12 in his right eye.

The authors note that the lack of expected improvement in the operated eye prompted further investigations.

An examination of optical coherence tomography (OCT) scans found a small defect in the fovea’s ellipsoid zone in both eyes.

The authors highlighted that a further history was taken from the patient, where he revealed that he had used poppers three to four times before his cataract surgery over a period of 18-months.

After referral to a medical retina consultant, the patient was advised about poppers maculopathy and agreed to stop using poppers.

He opted to go ahead with cataract surgery for his left eye – although he was given a guarded prognosis because of the underlying maculopathy.

His unaided visual acuity four months after his first cataract surgery was 6/9 bilaterally, which improved to 6/6 at eight months.

The authors highlighted that the OCT abnormalities remained even as the patient’s vision improved.

“Visual recovery from poppers maculopathy can be excellent after drug cessation despite ongoing abnormalities on OCT scans,” the clinicians shared.