Reacción ocular adversa a la acetazolamida: a propósito de un caso / Severe ocular side effects with acetazolamide: case report

CASO CLÍNICO: Mujer de 44 años que acude a urgencias por disminución de la agudeza visual (AV) en ambos ojos (AO) de 4h de evolución. Se observa miopización, aumento de la presión intraocular (PIO) en AO y cámara anterior (CA) de grado II. En la ecografía de segmento posterior se evidencia un desprendimiento coroideo en rodete periférico y en la de segmento anterior se mide un grosor cristaliniano de 4,05mm en el ojo derecho (OD) y 4,00mm en el ojo izquierdo (OI). La paciente está en tratamiento (vía oral) con naproxeno y acetazolamida, por migraña. Se suspende el tratamiento con acetazolamida y se pauta tratamiento tópico con timolol y brimonidina cada 12h, y prednisolona y ciclopentolato cada 8h. En los controles sucesivos se observa una disminución progresiva de la miopía, del grosor del cristalino y una ampliación de la cámara anterior. En el último control, el paciente acepta una esfera de −0,75 dioptrías (D) en el OD y de −0,25 D en el OI, la PIO es de 15mmHg en AO y la CA es de grado III. En la ecografía, el grosor del cristalino es de 3,59mm en el OD y de 3,61mm en el OI. Conclusión: Se trata de un caso de cierre angular agudo por desplazamiento del complejo irido-cristaliniano de causa iatrogénica, secundario al uso de acetazolamida. El tratamiento de esta entidad consiste en retirar el fármaco responsable del cuadro y administrar corticoides, hipotensores y ciclopléjico tópicos. Con esto se consigue disminuir la presión ocular y el grado de miopía gracias al reposicionamiento del diafragma irido-cristaliniano

CLINICAL CASE: A 44-year-old woman arrived in the emergency department complaining of decreased visual acuity (VA) in oculus uterque (OU) of 4hours onset. Signs of myopia, increased intraocular pressure (IOP) in OU, and a narrow grade II anterior chamber (AC) were observed. In the posterior segment ultrasound scan, a choroidal peripheral detachment is evident, and a lenticular thickness of 4.05mm is measured in the anterior segment of the right eye (OD) and 4.00mm in the left eye (OS). On treatment with oral with naproxen (non-steroidal anti-inflammatory drug), and acetazolamide for migraine. The acetazolamide is suspended and topical treatment is started with timolol and brimonidine every 12hours, with prednisolone and ayclopentolate every 8hours. In the follow-up, a gradual reduction of myopia and lens thickness is observed, as well as anterior chamber expansion. In the last control, the patient had a sphere of −0.75 diopters (D) in OD and −0.25 D in OS. IOP was 15mmHg in OU and AC was grade III. The ultrasound showed a lens thickness of 3.59mm in OD and 3.61mm in OS. Conclusion: This was an iatrogenic case of acute angle closure induced by an anterior displacement of the irido-lenticular complex, secondary to the use of acetazolamide. The treatment of this condition involves suspending the drug responsible and applying topical corticosteroids, hypotensive and cycloplegic eye drops, with the aim of lowering the eye pressure and the degree of myopia due to the re-positioning of the irido-lenticular complex

Severe ocular side effects with acetazolamide: case report. / Reacción ocular adversa a la acetazolamida: a propósito de un caso.

CLINICAL CASE: A 44-year-old woman arrived in the emergency department complaining of decreased visual acuity (VA) in oculus uterque (OU) of 4hours onset. Signs of myopia, increased intraocular pressure (IOP) in OU, and a narrow grade II anterior chamber (AC) were observed. In the posterior segment ultrasound scan, a choroidal peripheral detachment is evident, and a lenticular thickness of 4.05mm is measured in the anterior segment of the right eye (OD) and 4.00mm in the left eye (OS). On treatment with oral with naproxen (non-steroidal anti-inflammatory drug), and acetazolamide for migraine. The acetazolamide is suspended and topical treatment is started with timolol and brimonidine every 12hours, with prednisolone and ayclopentolate every 8hours. In the follow-up, a gradual reduction of myopia and lens thickness is observed, as well as anterior chamber expansion. In the last control, the patient had a sphere of -0.75 diopters (D) in OD and -0.25 D in OS. IOP was 15mmHg in OU and AC was grade III. The ultrasound showed a lens thickness of 3.59mm in OD and 3.61mm in OS. CONCLUSION: This was an iatrogenic case of acute angle closure induced by an anterior displacement of the irido-lenticular complex, secondary to the use of acetazolamide. The treatment of this condition involves suspending the drug responsible and applying topical corticosteroids, hypotensive and cycloplegic eye drops, with the aim of lowering the eye pressure and the degree of myopia due to the re-positioning of the irido-lenticular complex.