Unexplained Perivascular Chorioretinal Atrophy: Is Ranolazine a Possible Cause?

PURPOSE: To report a case of unexplained perivascular chorioretinal atrophy temporally associated with ranolazine use. CASE REPORT: A 64-year-old man with chronic stable angina pectoris was referred to our retina clinic with a complaint of an inferior visual field defect in the right eye over the last 1 month. The symptom onset coincided with the prescription of ranolazine extended-release 500 mg daily and slowly progressed over this period. Central and color vision were normal, and relative afferent pupillary defect was negative. Fundus exam showed chorioretinal atrophy in both eyes along the main vascular arcades, which was more prominent in the right eye and along the superior temporal arcade. Visual field assessment disclosed a double arcuate scotoma in both eyes. Swept-source optical coherence tomography showed outer retina, retinal pigment epithelium, and choriocapillaris atrophy in the extrafoveal area. Fundus autofluorescence showed hypo-autofluorescence, and fluorescein angiography revealed staining along the vascular arcades. Electroretinogram disclosed abnormal photopic and scotopic responses. All findings were more prominent in the right eye and along the superior temporal arcade. Ranolazine intake was stopped. Three months after drug cessation, the patient's visual field and electroretinogram improved. CONCLUSION: This is the first case report on ranolazine-associated chorioretinal toxicity, highlighting the necessity of further studies on potential side effects of even short-term exposure to this drug.