http://informahealthcare.com/cot ISSN: 1556-9527 (print), 1556-9535 (electronic) Cutan Ocul Toxicol, Early Online: 1–4 ! 2015 Taylor & Francis DOI: 10.3109/15569527.2015.1072547 RESEARCH ARTICLE The short-term and long-term adverse ocular effects of fesoterodine fumarate Damla Erginturk Acar 1 , Ugur Acar 2 , Ozdemir Ozdemir 1 , Zuhal Ozen Tunay 1 , and Sabri Cavkaytar 3 1 Department of Ophthalmology, Zekai Tahir Burak Women’s Health Education and Research Hospital, Ankara, Turkey, 2 Department of Ophthalmology, Hacettepe University, Faculty of Medicine, Ankara, Turkey, and 3 Department of Urogynecology, Zekai Tahir Burak Women’s Health Education and Research Hospital, Ankara, Turkey Abstract Aim: To evaluate the short-term and long-term effects of fesoterodine fumarate treatment which is used for overactive bladder (OAB) on pupil diameter (PD), intraocular pressure (IOP) and accommodation amplitude (AA). Method: Ophthalmic examination was performed before and after receiving medication (on the 30th and 90th day) on 120 eyes of 120 women whom were planned to begin anticholinergic treatment (fesoterodine fumarate, 4 mg/day, peroral) for OAB, prospectively. The changes in PD, IOP and AA were analyzed statistically. Results: The mean age of 120 women was 52.06 ± 9.39 years (30–70 years). The mean PD, IOP and AA values were 4.12 ± 0.61 mm (3.00–5.70 mm), 15.58 ± 1.74 mmHg (11–20 mmHg) 2.28 ± 1.26 Diopter (D) (0.50–5.50 D) at baseline; 4.68 ± 0.65 mm (3.20–5.80 mm), 16.11 ± 1.72 mmHg (11–20 mmHg), 1.68 ± 1.04 D (0.25–4.50 D) at 30th day; and 4.28 ± 0.58 mm (3.10– 5.70 mm), 16.09 ± 1.96 mmHg (11–19 mmHg), 2.18 ± 1.19 D (0.50–5.00 D) at 90th day, respect- ively. Although increases in PD values and decreases in AA values were statistically significant (p50.001 for each), the changes in IOP values were not as such (p ¼ 0.642). Visual complaint was not observed in any patient. Discussion: The newest anticholinergic medication in women with OAB increased the PD and decreased the AA statistically significantly. Clinically, it seems to be well-tolerated by the patient. Keywords Accommodation amplitude, fesoterodine fumarate, intraocular pressure, overactive bladder, pupil diameter History Received 9 June 2015 Revised 2 July 2015 Accepted 9 July 2015 Published online 12 August 2015 Introduction Overactive bladder (OAB) is a symptom complex, accom- panied by urgency, urination and nocturia without any underlying pathological condition 1 . OAB should be cared meticulously, since it causes social and/or hygienic problems and reduce patients’ quality of life 2 . Initially, conservative and behavioral therapies such as regular liquid consumption, making bladder exercises and voiding on time should be recommended to the patients with OAB according to The National Institute for Health and Clinical Excellence (NICE) 3 . When these precautions fail, an oral anticholinergic drug such as oxybutynin, tolterodine, trospium, propiverine, darifenacin, solifenacin and fesoterodine fumarate is generally initiated 4 . Fesoterodine fumarate, which is a newly approved anti- cholinergic drug, is among the most commonly used anticholinergic drugs. Fesoterodine fumarate and its active metabolite [5-hydroxymethyl tolterodine (5-HMT)] are com- petitive non-selective inhibitors of muscarinic receptors, and they are metabolized mostly through kidney and liver 5,6 . Some obstetricians and urologists hesitate to prescribe anticholinergic drugs, because of their ocular side effects. The muscarinic receptors are located not only on detrusor smooth muscle fibers in the bladder, but also in eyes, salivary glands and bowel 6,7 . Although some ocular adverse effects such as blurring vision and esotropia depending on the decrease in accommo- dation amplitude (AA), dry eye and acute-angle closure glaucoma were reported in patients taking anticholinergic drugs 8–12 , there are prospective randomized studies supporting that these drugs are safe in terms of intraocular pressure (IOP) and AA 7,9,13–15 . In this prospective study, we aimed to evaluate the short- term (30th day) and long-term (90th day) effects of 4 mg/day fesoterodine fumarate (Toviaz Õ ; Pfizer, Turkey) on pupil diameter (PD), IOP and AA in patients with OAB. To the best of our knowledge, there is no current study in the literature about the ocular adverse effects of fesoterodine fumarate and long-term ocular adverse effects of any anticholinergic drugs. Materials and methods This prospective study was performed in accordance with the Declaration of Helsinki and it was approved by the Local Address for correspondence: Dr Damla Erginturk Acar, MD, Department of Ophthalmology, Zekai Tahir Burak Women’s Health Education and Research Hospital, Ankara, Turkey. E-mail: erginturk@yahoo.com Cutaneous and Ocular Toxicology Downloaded from informahealthcare.com by Hacettepe Univ. on 08/28/15 For personal use only.