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In recent years, the range of combined narcotic drugs has widened. New chemical modifications have emerged, including so-called designer drugs, whose action on the body and in particular on the state of vision is increasingly difficult to determine. While the problem of drug abuse is growing drastically, timely detection of a possible toxic damage to the eye induced by drugs and reliable diagnosis differentiating such damage from other etiologies becomes a topical practical issue. The paper presents a clinical case of poppers maculopathy (poppers being a slang name of aromatic volatile alkyl nitrite compounds). Ophthalmological manifestations and differential diagnostic criteria of the damage are described. The mechanisms of action and possible treatment methods are discussed.

Purpose To investigate a possible microvascular component of poppers maculopathy (PMP) using optical coherence tomography angiography (OCTA). Methods Twelve patients suffering from poppers maculopathy were included. Health records, optical coherence tomography (OCT), and OCTA data was gathered and compared to a healthy control group (HC). PMP lesion type was determined by manifestation in OCT. OCTA-based evaluation of retinal vascular plexus and choriocapillaris (CC) was executed. Vessel density (VD) and vessel length density (VLD) in superficial and deep capillary plexus (SCP, DCP), as well as flow deficits (FD), within the foveal avascular zone (FAZ) in CC were assessed. Results Median age of PMP patients was 40 (min 24; max 64) years, all male. Eleven patients presented with ellipsoid zone-type lesions; one patient showed a vitelliform-type lesion. No qualitative microvascular changes between PMP patients and HC were identified. Quantitative values for VD and VLD of SCP and DCP did not differ in between the two groups. The analysis of FDs in CC showed no deviation from PMP patients to HC. Conclusions No vascular anomalies in qualitative and quantitative analysis in OCTA were detected in PMP patients. The constitution of the CC within FAZ of PMP patients does not differ from HC when assessed as FD.

Purpose To use new adaptive optics scanning laser ophthalmoscopy (AOSLO) technology to better image macular pathology in poppers maculopathy. Observations A 40-year-old patient was found to have poppers maculopathy. Best corrected visual acuity was decreased to 20/40 OD and 20/50 OS, spectral domain optical coherence tomography found outer retinal disruption of the fovea, and AOSLO imaging showed significant decrease in cone density of the fovea of both eyes. Conclusions and importance Poppers maculopathy is a rare, but visually significant, complication of popper abuse. AOSLO technology demonstrates significant cone damage in poppers maculopathy. The striking loss of cones revealed by AOSLO imaging shows how AOSLO imaging can elucidate macular pathology., Highlights • Poppers maculopathy can cause a significant decrease in BCVA despite relatively minimal changes observed on DFE and SD-OCT. • AOSLO imaging in this case of poppers maculopathy reveals a striking decrease in central cone density. • This report demonstrates that AOSLO can elucidate macular pathology not seen in more widely used retinal imaging modalities.

Purpose: To describe a case of poppers maculopathy by means of multimodal imaging. Methods: A 26-year-old male presented to our Department in April 2018 with a history of visual disturbances. He underwent a complete ophthalmologic examination, including optical coherence tomography, fundus autofluorescence, and ultra-widefield fundus photograph. Results: At baseline, the patient presented a visual acuity of 20/25 Snellen bilaterally, with an altered foveal reflex on funduscopic examination. Structural optical coherence tomography showed disruption of the outer retinal layers in both eyes. After 6-month observation, the status of the outer retinal layers on optical coherence tomography and his vision (20/20) appeared improved. In this occasion, we performed optical coherence tomography angiography that revealed clear and persisting choriocapillaris alterations. Upon further interrogation, he admitted the episodic use of poppers, hence leading to the diagnosis. Conclusion: Our findings suggest that microvascular toxicity at the level of choriocapillaris may act as primary pathogenetic insult in poppers maculopathy.