Visual disturbance secondary to clomiphene citrate.
1: Arch Ophthalmol. 1995 Apr;113(4):482-4.
Purvin VA.
Midwest Eye Institute, Methodist Hospital of Indiana, Indianapolis, USA.
OBJECTIVE: To identify a distinctive constellation of persistent visual abnormalities secondary to treatment with clomiphene citrate. DESIGN: Description of the clinical findings in three patients with visual disturbance secondary to clomiphene treatment. SETTING: A neuro-ophthalmology referral center. PATIENTS: Three women aged 32 to 36 years treated for infertility with clomiphene for 4 to 15 months. RESULTS: All three patients experienced prolonged afterimages (palinopsia), shimmering of the peripheral field, and photophobia while undergoing treatment with clomiphene. The results of the neuro-ophthalmologic examination and electrophysiologic studies were normal in all three patients. Unlike previously reported cases, visual symptoms did not resolve on cessation of treatment. Patients remain symptomatic from 2 to 7 years after discontinuing treatment with the medication. CONCLUSIONS: Treatment with clomiphene can cause prolonged visual disturbance. Patients who develop such symptoms should be advised that continued administration may cause irreversible changes. Women with characteristic visual symptoms should be questioned about past use of clomiphene.
PMID: 7710399 [PubMed - indexed for MEDLINE]
An interesting tie-in between Metformin and Clomid from this abstract:
Effects of Metformin on Spontaneous and Clomiphene-Induced Ovulation in the Polycystic Ovary Syndrome
John E. Nestler, M.D., Daniela J. Jakubowicz, M.D., William S. Evans, M.D., and Renato Pasquali, M.D.
ABSTRACT
Background Obese women with the polycystic ovary syndrome are relatively unresponsive to the induction of ovulation by clomiphene. We hypothesized that reducing insulin secretion by administering metformin would increase the ovulatory response to clomiphene.
Methods We performed oral glucose-tolerance tests before and after the administration of 500 mg of metformin or placebo three times daily for 35 days in 61 obese women with the polycystic ovary syndrome. Women who did not ovulate spontaneously were then given 50 mg of clomiphene daily for five days while continuing to take metformin or placebo. Serum progesterone was measured on days 14, 28, 35, 44, and 53, and ovulation was presumed to have occurred if the concentration exceeded 8 ng per milliliter (26 nmol per liter) on any of these days.
Results
Twenty-one women in the metformin group and 25 women in the placebo group were given clomiphene because they did not ovulate spontaneously during the first phase of the study. Among the 21 women given metformin plus clomiphene, the mean (±SE) area under the serum insulin curve after oral glucose administration decreased from 6745±2021 to 3479±455 µU per milliliter per minute (40.5±12.1 to 20.9±2.7 nmol per liter per minute, P=0.03), but it did not change significantly in the 25 women given placebo plus clomiphene. Nineteen of the 21 women (90 percent) who received metformin plus clomiphene ovulated (mean peak serum progesterone concentration, 23.8±3.4 ng per milliliter [7.6±10.9 nmol per liter]). Two of the 25 women (8 percent) who received placebo plus clomiphene ovulated (P<0.001). Overall, 31 of the 35 women (89 percent) treated with metformin ovulated spontaneously or in response to clomiphene, as compared with 3 of the 26 women (12 percent) treated with placebo.
Conclusions
The ovulatory response to clomiphene can be increased in obese women with the polycystic ovary syndrome by decreasing insulin secretion with metformin.
Source Information
From the Departments of Medicine at the Medical College of Virginia, Virginia Commonwealth University, Richmond (J.E.N.); Hospital de Clinicas Caracas, Caracas, Venezuela (D.J.J.); the University of Virginia, Charlottesville (W.S.E.); and the University of Bologna, Bologna, Italy (R.P.).
Address reprint requests to Dr. Nestler at the Medical College of Virginia, P.O. Box 980111, Richmond, VA 23298-0111.