Supplementary Material for: When Erectile Dysfunction Therapy Clouds the Vision: ST-BRVO After Sildenafil in a Healthy Male

Background:
Sildenafil, a widely prescribed phosphodiesterase-5 (PDE5) inhibitor for erectile dysfunction, is generally well-tolerated. However, ocular vascular complications—including non-arteritic anterior ischemic optic neuropathy (NAION), central serous chorioretinopathy, and retinal vein occlusion (RVO)—have been reported. Though rare, such events can occur even in individuals without conventional systemic risk factors.
Case Presentation:
A 55-year-old man with no prior medical history developed sudden, painless visual blurring in his right eye 48 hours after ingesting a single 100 mg dose of sildenafil. Clinical evaluation revealed a superotemporal branch retinal vein occlusion (ST-BRVO) with macular edema. A comprehensive systemic and hematologic workup, including thrombophilia screening and cardiac evaluation, yielded normal results. The patient was treated with an intravitreal injection of bevacizumab, leading to anatomical and visual improvement.
Conclusion:
This case draws attention to a possible association between sildenafil use and retinal vascular events, particularly BRVO, even in healthy individuals. The temporal proximity and absence of systemic risk factors suggest a potential dose-independent vascular susceptibility. Clinicians should be aware of this rare but potentially vision-threatening complication.