Bilateral Acute Angle Closure Attack and Choroidal Detachment in Patient with Acquired Immune Deficiency Syndrome

PURPOSE: To report a case of simultaneous bilateral acute angle closure attack combined with bilateral choroidal detachment in a patient with acquired immune deficiency syndrome (AIDS).CASE SUMMARY: A 63-year-old male who had a history of several months of diarrhea, abdominal pain, and weight loss visited the emergency room with sudden bilateral blurred vision accompanied with headache, periocular pain, nausea, and vomiting. His visual acuity was finger counting in both eyes and the intraocular pressure (IOP) was 49/44 mmHg (right/left). The anterior chamber depth was three times the corneal thickness in the center and less than 1/4 of the corneal thickness in the periphery in both eyes. Maximum medical therapy had no effect and emergency cataract surgery combined with vitrectomy was performed on the right eye. During surgery, severe choroidal detachment was noted. One day after surgery, choroidal detachment was also found in the left eye and emergency cataract surgery with suprachoroidal fluid drainage was performed. Approximately 1 month after surgery, choroidal detachment of both eyes regressed without systemic therapy. The IOP was 14/7 mmHg (right/left) with a visual acuity of 0.32/0.4 (right/left). The blood test performed in the emergency room showed a positive result for AIDS and the patient started medical therapy.CONCLUSIONS: In patients with AIDS, bilateral simultaneous acute angle closure attack combined with choroidal detachment may rarely develop. Although choroidal effusion can regress spontaneously, combined suprachoroidal fluid drainage is recommended when a surgical intervention is required.

A Case of Bilateral Acute Angle Closure Attack Induced by Common Cold Medication

PURPOSE: The authors report a case of bilateral simultaneous acute angle closure attack following administration of an over-the-counter common cold medication (ingredients: chlorpheniramine maleate, phenylephrine hydrochloride, and belladonna alkaloid). CASE SUMMARY: A 67-year-old man visited the emergency room with a sudden onset of bilateral blurred vision and ocular pain accompanied by headache, nausea, and vomiting. He had taken an over-the-counter common cold medication three times per day for three days before the visit. His visual acuity was 0.3 and 0.7 and intraocular pressure (IOP) was 50 mm Hg and 40 mm Hg in right and left eye, respectively. The refraction in manifest refractive test was +0.75 D sph = -0.75 D cyl x 100 in right eye and +1.25 D sph = -1.25 D cyl x 80 in left eye. The anterior chamber depth was three times the corneal thickness in center and less than 1/4 of the corneal thickness in periphery in both eyes on van Herick method. The angles of both eyes were closed on gonioscopy. He was treated with ocular hypotensive medication and miotics followed by withdrawal of common cold medications. After 10 days, bilateral neodymium-doped yttrium aluminium garnet (Nd:YAG) laser peripheral iridotomies were done. During four months of follow-up, there was no recurrence of angle closure attack, and normal IOP was maintained without glaucoma medications. CONCLUSIONS: Common cold medications which are easily accessible can induce acute angle closure attack in those who are predisposed to develop angle closure attacks, hence attention must be taken in those people when taking common cold medications.

Bilateral Simultaneous Acute Angle Closure Glaucoma Following Sexual Intercourse Aided by Sildenafil Citrate

PURPOSE: The authors of the present study report a case of bilateral simultaneous acute angle closure glaucoma following sildenafil citrate-aided sexual intercourse. CASE SUMMARY: A 63-year-old man visited the emergency department with sudden onset of bilateral ocular pain and blurred vision. The patient had taken 50 mg sildenafil citrate followed by sexual intercourse. His visual acuity on presentation was 0.3 in the right eye and 0.5 in the left eye. Intraocular pressure (IOP) was 54 mm Hg and 46 mm Hg in the right and left eye, respectively. Anterior chamber depths were shallow and angles were closed on gonioscopy in both eyes. The patient was treated with ocular hypotensive medication and subsequently managed with bilateral YAG laser peripheral iridotomies. During the 13 months of follow-up, there was no recurrent angle closure attack and IOPs were well-controlled. CONCLUSIONS: The mechanism of bilateral angle closure glaucoma caused by sildenafil citrate is not proven. Those who are predisposed towards developing angle-closure glaucoma may be at risk when having sexual intercourse aided by sildenafil citrate.

Bilateral simultaneous acute angle closure caused by sulphonamide derivatives: A case series.

The sulphonamide group of drugs is implicated in bilateral acute angle closure (AAC) due to an idiosyncratic response. We report a series of three cases with bilateral AAC caused by different sulphonamide derivatives, their presentation and management.