Weiler Danielle L
*OD, FAAO Southern Arizona Veterans Affairs Health Care System, Sierra Vista, Arizona; and Southern California College of Optometry at Marshall B. Ketchum University, Fullerton, California.
Optom Vis Sci. 2015 Feb;92(2):e46-51. doi: 10.1097/OPX.0000000000000475.
To present a previously unreported case of angle closure secondary to the sulfonamide derivative zonisamide, to introduce eye care providers to zonisamide, and to review sulfonamide-induced angle closure. Zonisamide is a relatively new sulfonamide derivative indicated for epilepsy and used off-label for migraines. Although angle closure secondary to systemic medications such as topiramate and other sulfonamide derivatives is well documented, this is the first case of zonisamide-induced angle closure and myopic shift to be reported.
A 39-year-old Hispanic woman presented with sudden vision loss OU with a concurrent bilateral frontal headache. No changes in health were reported other than initiating zonisamide for refractory migraines 2 weeks prior. Ocular history was significant only for low myopia. Entering visual acuities were 20/400 OD, OS. Manifest refraction revealed a 3-diopter myopic shift OU with best-corrected visual acuities of 20/20 OD, OS. On slit lamp examination, the anterior chamber angles were narrow OU and gonioscopy confirmed partially occluded angles OU. The intraocular pressures were elevated OU. B-scan ultrasonography exhibited peripheral choroidal effusion OU. With discontinuation of zonisamide, the patient experienced full recovery.
With increasing use of zonisamide, practitioners should be aware of its sulfonamide derivative properties and the risk of secondary angle closure.
报告一例此前未报道过的因磺胺类衍生物唑尼沙胺导致的闭角型青光眼病例，向眼科护理人员介绍唑尼沙胺，并回顾磺胺类药物引起的闭角型青光眼。唑尼沙胺是一种相对较新的磺胺类衍生物，用于治疗癫痫，也被用于偏头痛的非标签治疗。虽然托吡酯等全身性药物及其他磺胺类衍生物导致闭角型青光眼已有充分记录，但这是首例报道的唑尼沙胺引起的闭角型青光眼和近视性移位病例。
一名39岁的西班牙裔女性因双眼突然视力丧失并伴有双侧额部头痛前来就诊。除了在2周前开始服用唑尼沙胺治疗难治性偏头痛外，未报告其他健康状况变化。眼部病史仅有低度近视。初诊视力右眼和左眼均为20/400。显验光显示双眼近视性移位3屈光度，最佳矫正视力右眼和左眼均为20/20。裂隙灯检查显示双眼前房角狭窄，前房角镜检查证实双眼房角部分关闭。双眼眼压升高。B超检查显示双眼周边脉络膜积液。停用唑尼沙胺后，患者完全康复。
随着唑尼沙胺使用的增加，从业者应意识到其磺胺类衍生物的特性以及继发性闭角型青光眼的风险。
