Vision loss following poppers intake could be considered to be a rare event, although in Web forums discussing poppers effects, photopsia is reported as a common adverse effect. To our knowledge, during the past 10 years there have been only 2 case reports of vision loss following inhalation of poppers.4,5 A similar case of vision loss has been reported by Pece et al,4 in which a patient experienced acute, bilateral vision loss hours after inhaling isobutyl nitrite. He had no significant past medical, ophthalmic or family history. It’s history began as early as when French chemist Antoine Balard first synthesized amyl nitrite in 1844. Even then, Balard noted that smelling the chemical’s vapor made him lightheaded. Most of those dancing were inhaling ‘poppers’ or amyl nitrite, from tiny brown bottles which many kept in their fridges. “It is not thought that amyl leads to many long-term issues, but there are some short-term risks,” Dr Boylan says.
Bisexual and gay men are disproportionately affected by HIV/AIDS. While bisexual men reported lower rates of unprotected sex, logistic regression analysis found that current use of poppers and ED drugs, which were higher among gay men, explained this difference. In patients who underwent fluorescein angiography, a centrofoveal window defect was found but no evidence of fluid leakage. Subsequently, visual evoked potentials were found to be normal, which led to prednisolone discontinuation. A presumptive diagnosis of optic neuritis led to prednisolone bolus therapy (1 mg/kg). The case described by Fledelius5 was of acute and severe bilateral optic neuropathy, but the relationship with poppers was disputable; viral optic neuritis was a more likely diagnosis. Among a sample of 239 HIV-positive bisexual and gay men aged 50 and older, bisexual men were more likely to report cigarette, cocaine, crack, and heroin use compared with gay men. MS. TIPPETT: I think we have time for one more question. The mother doesn’t have to audition for this role. Finally, the determination of the molecular basis of the toxic effects of poppers may be of interest to further document the role of NO in retinal function and diseases and to identify protective mechanisms against such toxicity.
Nitrite inhalants called “poppers” are receiving renewed attention by researchers regarding the drug’s role in the gay community, its contribution to risky sexual behavior, and its ability to fuel the AIDS epidemic. There is little knowledge regarding the pharmacological effects of inhaled alkyl nitrites on neural tissues.7,8 At physiological doses, NO modulates photoreceptor metabolism and function,9,10 in particular through activation of guanylate cyclase, a key enzyme of phototransduction.11 The presence of photopsias in many patients suggests permanent activation of central cones rather than their inhibition, which would be expected if only guanylate cyclase activation was involved. Improvement after interruption appears to be the rule, although our data are still incomplete regarding this point. Accordingly, an increased ERG after NO administration was described in rats,12 and another study suggested that NO potentiates the light response of cones, while it decreases that of rods.13 At higher doses, it has been shown that photoreceptors are among the most sensitive retinal neurons to the toxic effects of NO, both in vitro and in vivo.14,15 Nitric oxide is also known to decrease the threshold of light toxicity.16,17 Yet, these studies were performed in retinas that do not have a fovea; thus, their relevance to the clinical toxicity described here is questionable.
However, the putative mechanisms linking poppers to retinal toxicity remain elusive. Consumers and ophthalmologists should be aware of the possible long-term retinal toxicity of isopropyl nitrite, and possibly of all brands of poppers. Isopropyl nitrite has been identified in the vials taken by 3 of them. Given the absence of a detectable contaminant in the poppers vials examined to date, it is likely that visual symptoms were directly linked to NO intake. A complete or a partial regression of symptoms and fundus abnormalities was noted in the 4 patients who claimed to have discontinued popper intake. Research typically combines these groups into the category of men who have sex with men, and little is known about between-group differences. HIV-positive populations are aging and have high rates of substance use compared to non-infected peers, while substance use among older adults has increased and is associated with unprotected intercourse. Their use has been associated with HIV sexual risk behaviours including receptive anal sex. All patients described here were HIV positive; however, this is probably coincidental because poppers are popular among the gay community and the cases described by us6 were in HIV-negative subjects. He added that a ban would astonish the gay community while also driving the supply underground.
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