RESUMEN
We report the case of a 29-year-old epileptic woman who had been on treatment with topiramate 25mg/day for 9 days. She was referred to the Emergency Department due to reduction in far visual acuity (VA) after increasing the dose to 50mg/day two days before. The ocular examination showed bilateral acute angle closure glaucoma (AACG) and macular striae in both eyes (AO) observed by Retinography and Optical Coherence Tomography (OCT). The AACG is a well-known side effect of topiramate, but the macular striae rarely accompanies it. Although macular striae have been previously described in other cases, very few document those using retinography and OCT images. Therefore, it is important to differentiate a case of AACG induced by topiramate from a case of primary AACG, since they differ in their clinical presentation, mechanism of action, and treatment. Mismanagement can have potentially serious consequences.
Asunto(s)
Anticonvulsivantes/efectos adversos , Glaucoma de Ángulo Cerrado/inducido químicamente , Mácula Lútea , Miopía/inducido químicamente , Enfermedades de la Retina/inducido químicamente , Topiramato/efectos adversos , Enfermedad Aguda , Adulto , Femenino , HumanosRESUMEN
CLINICAL CASE: A case of surgical removal of a subfoveal perfluorocarbon liquid (PFCL) bubble that remained trapped inside the subretinal space. PFCL bubble extraction was performed by performing a therapeutic and vacuum PFCL bubble macular retinal detachment. DISCUSSION: The elapsed time before subfoveal PFCL extraction seems to influence the visual result. There are other factors which could influence the final visual acuity significantly, nevertheless it is possible to achieve useful vision, as long as the fovea is not damaged and iatrogenic injuries are avoided during PFCL bubble extraction.
Asunto(s)
Fluorocarburos , Complicaciones Posoperatorias/cirugía , Anciano , Fóvea Central , Humanos , Masculino , Procedimientos Quirúrgicos Oftalmológicos , Factores de TiempoRESUMEN
CASE REPORT: A 69 year-old woman was referred for a routine visit, during which funduscopy revealed white-yellow subretinal lesions in the superotemporal mid-periphery of both eyes. A and B scan ultrasound showed hyperechogenic lesions located at scleral and choroidal level. Computed tomography revealed posterolateral sclerochoroidal calcifications. Metabolic studies showed a severe vitamin D deficiency with no other remarkable findings. DISCUSSION: Sclerochoroidal calcifications are an infrequent finding that occur as a result of calcium deposit at scleral and choroidal level. They have a characteristic clinical picture and are idiopathic in most cases, but may be associated with some systemic diseases, such as calcium and phosphorous metabolic disorders; this fact warrants a thorough metabolic study. We report a case of bilateral sclerochoroidal calcifications associated with severe vitamin D deficiency with no other significant metabolic findings.
Asunto(s)
Calcinosis/etiología , Enfermedades de la Coroides/etiología , Enfermedades de la Esclerótica/etiología , Deficiencia de Vitamina D/complicaciones , Anciano , Femenino , HumanosRESUMEN
PURPOSE: To present a unique case of a 33-year-old woman using paroxetine who presented with acute unilateral visual loss due to chronic angle-closure glaucoma. METHODS: Case report. RESULTS: A 33-year-old women who had been under paroxetine treatment for the past four months presented at the emergency room due to a sudden loss of visual acuity (VA) in the left eye (LE). Narrow anterior chamber was detected. Intraocular pressure (IOP) was 29 mmHg right eye (RE) and 42 mm Hg LE. A fundus exam revealed a cup-to-disc ratio of 0.9-1 for the LE and of 0.1-0.2 for the RE. Paroxetine treatment was suspended, and after 48 h IOP was 10 mm Hg in both eyes (BE). ND-YAG laser iridotomy was performed in BE. In the subsequent visit, IOP was 25 mm Hg in the RE and 41 mm Hg in the LE; on her own initiative the patient had resumed paroxetine treatment. After requesting the patient again to stop taking the anti-depressant, IOP was 10 mm Hg in BE in the next exam 48 h later. CONCLUSIONS: As far as we are aware, there are no other reports of chronic angle-closure glaucoma related to the use of paroxetine. We thus consider that, before initiating treatment with this drug, patients should be informed of its potential ocular risks and they should be subjected to an ophthalmologic examination before its use is authorized.