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Branch retinal vein occlusion and anabolic steroids abuse in young bodybuilders

2008; Wiley; Volume: 87; Issue: 5 Linguagem: Inglês

10.1111/j.1755-3768.2008.01238.x

1755-3768

Eduardo de França Damasceno, Armando Magalhães Neto, Nadyr A Damasceno, Soraya Horowitz, Haroldo Vieira de Moraes,

Pharmacology and Obesity Treatment

Editor, Anabolic steroids are often misused by athletes who participate in sports that demand strength or muscular resistance. Because these drugs increase muscle mass and strength, there is significant potential for abuse among young bodybuilders preparing for competitive exhibition (Hartgens & Kuipers 2004). We describe two young bodybuilders who developed ocular complications related to their misuse of anabolic steroids. Both patients were in good general health, yet both developed retinal venous occlusive disease (Rogol 2000;Hartgens & Kuipers 2004). A 21-year-old male was seen in January 2000 with a complaint of rapid onset of visual blurring in the left eye. His right eye appeared normal. Visual acuity (VA) was 20/20 OD and 20/30 OS. The left retina showed diffuse retinal haemorrhages along the superotemporal arcade with associated areas of hard exudate (Fig. 1). Case 1. Colour retinography in the left eye showing ocular fundus with branch retinal vein occlusion. The patient admitted to having used anabolic steroids for the previous 6 months. In addition, he reported that he was eating a hyperprotein diet with supplemental essential amino acids (glutamic acid and taurine) and was drinking distilled water without mineral salts. He was taking furosemide (40 mg) twice weekly and oral nandrolone, an anabolic-androgenic steroid, (25 mg) daily. He had also been receiving growth hormone injections (1200 IU i.m.) every 2 months. Fluorescein angiography revealed a superotemporal branch retinal vein occlusion (BRVO) with minimal macular oedema and no neovascularization. An 18-year-old male was seen in February 2000 after noting 'tiny mobile flies' in his field of vision OS. On examination, the right eye was normal. Visual acuity was 20/20 OD and 20/25 OS. The left retina exhibited mild perimacular haemorrhages compatible with a superotemporal BRVO. The patient admitted to regular ingestion of anabolic steroids for almost 1 year prior to his assessment. His diet consisted of a high protein intake, supplemented with essential amino acids. He drank distilled water and had been taking oral furosemide (40 mg) twice per week, and oral decadurobolin and stanozolol, two anabolic-androgenic steroids, (5 mg) three times per week. Fluorescein angiography confirmed the diagnosis of BRVO. The side-effects of anabolic steroids include behavioural and clinical alterations. There is a high rate of hepatotoxicity among anabolic steroid users, leading to cirrhosis and cardiovascular disorders (Dhar et al. 2005). The aetiology of the type of venous obstruction these two bodybuilders experienced appears to include three factors: increased blood viscosity; a disorder of the vascular wall of the blood vessels, and arterial hypertension, which compresses the common arteriovenous sheath at the site of an arteriovenous crossing. Among the longterm cardiovascular effects of steroids is an increased cardiac debit (caused by a higher metabolism), which often leads to arterial hypertension. Another consequence is an alteration in the metabolism of lipoproteins, giving rise to hypercholesterolaemia and hypertriglyceridaemia. In addition, the habitual use of diuretics and distilled drinking water in an attempt to improve the appearance of the muscle mass can increase blood viscosity (Ring et al. 1976; McGrath et al. 1978; Dodson et al. 1982). Both patients fared well, regaining perfect VA within several months of stopping their drug ingestion, similarly to other cases (Jampol & Fleishman 1981).