Department of Ophthalmology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
Department of Advanced Device Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
BMC Ophthalmol. 2021 Nov 4;21(1):386. doi: 10.1186/s12886-021-02147-3.
Indapamide, a sulfonamide diuretic used to treat hypertension, has been reported to have ocular side effects of acute angle-closure glaucoma, transient myopia and choroidal effusion whose immediate etiology is uncertain. This report aims to clarify the nature of indapamide-induced edema of the entire eyeball using multimodal imaging.
A 60-year-old woman who was following a long-term carbohydrate-restricted diet and receiving oral treatment for hypertension was referred to our department for eye pain. Indapamide (1 mg daily) was prescribed for uncontrolled hypertension 5 days before her visit; she took the medication for only 3 days and then stopped due to dry eye. However, she began to feel eye pain the day after her last dose, and the pain gradually intensified. She experienced no decrease in visual acuity at the initial visit; however, an extremely shallow anterior chamber was observed in both eyes, along with a slight increase in intraocular pressure. For differential diagnosis, ocular manifestations were evaluated with wide-field fundus photography, optical coherence tomography (OCT) of both anterior and posterior segments, fluorescein / indocyanine green angiography, ultrasound biomicroscopy and head magnetic resonance, showing edema of the entire eyeball. Treatment with tropicamide and phenylephrine hydrochloride drops resulted in rapid recovery of the anterior chamber depth and disappearance of the choroidal effusion within 3 days.
Multimodal imaging is useful for diagnosing drug-induced choroidal effusion by evaluating ocular conditions before and after treatment.
吲达帕胺是一种磺胺类利尿剂，用于治疗高血压，已报道其具有急性闭角型青光眼、短暂性近视和脉络膜积液等眼部副作用，其直接病因尚不确定。本报告旨在通过多模态成像阐明吲达帕胺引起的整个眼球水肿的性质。
一位 60 岁女性，长期接受低碳水化合物饮食，并接受口服高血压治疗，因眼部疼痛被转至我科。吲达帕胺（每天 1 毫克）在她就诊前 5 天被开用于控制不佳的高血压；她仅服药 3 天，因眼睛干涩而停药。然而，她在最后一次服药后的第二天开始感到眼部疼痛，并且疼痛逐渐加剧。初次就诊时她的视力没有下降；然而，双眼的前房极浅，眼压略有升高。为了进行鉴别诊断，对眼部表现进行了广角眼底照相、前后节光学相干断层扫描（OCT）、荧光素/吲哚青绿血管造影、超声生物显微镜和头部磁共振成像检查，结果显示整个眼球水肿。使用托吡卡胺和盐酸苯肾上腺素滴眼液治疗后，前房深度迅速恢复，3 天内脉络膜积液消失。
通过评估治疗前后的眼部情况，多模态成像有助于诊断药物引起的脉络膜积液。
