Yoshida Sayaka, Yoshida Masaaki, Himori Noriko, Kunimatsu-Sanuki Shiho, Nakazawa Toru
Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, JPN.
Department of Aging Vision Healthcare, Tohoku University Graduate School of Biomedical Engineering, Sendai, JPN.
Cureus. 2022 Feb 8;14(2):e22036. doi: 10.7759/cureus.22036. eCollection 2022 Feb.
Acute primary angle closure (APAC) is rare in young adults (those under approximately 40 years old) and pregnant women. Here, we report the case of a 37-year-old primigravid woman with APAC caused by plateau iris after the use of ritodrine (a β2 stimulator) that was successfully resolved by clear-lens extraction five months after delivery. The patient presented with pain in her right eye after ritodrine infusion for threatened premature labor at 23 weeks of gestation. Her visual acuity was 20/40, and her intraocular pressure (IOP) was 31 mmHg in her right eye. The patient was diagnosed as having APAC with plateau iris based on ultrasound biomicroscopy (UBM) findings of irido-angle touch, anterior dislocation of the ciliary process, and an absent ciliary sulcus. The effectiveness of treatment with pilocarpine eyedrops was limited, and argon laser peripheral iridoplasty did not succeed in reducing IOP. An immediate resolution was achieved with clear-lens extraction. IOP has since stayed within 14-16 mmHg without any medication for seven years. This is the first reported case of APAC complicated with plateau iris after ritodrine use in a pregnant woman. This condition is rare in young adults, making it difficult to diagnose; however, UBM can be of great help. In this case, clear-lens extraction led to a successful outcome. Our case suggests that attention should be paid to drug associations when APAC occurs with plateau iris.
急性原发性闭角型青光眼（APAC）在年轻成年人（约40岁以下）和孕妇中较为罕见。在此，我们报告一例37岁初产妇，在使用利托君（一种β2激动剂）后因高褶虹膜导致APAC，产后五个月通过透明晶状体摘除术成功治愈。该患者在妊娠23周因先兆早产输注利托君后出现右眼疼痛。其右眼视力为20/40，眼压（IOP）为31 mmHg。根据超声生物显微镜（UBM）检查发现虹膜 - 房角接触、睫状体前脱位和睫状沟消失，该患者被诊断为高褶虹膜型APAC。毛果芸香碱滴眼液治疗效果有限，氩激光周边虹膜成形术未能成功降低眼压。透明晶状体摘除术立即取得了疗效。此后七年来，眼压一直维持在14 - 16 mmHg，无需任何药物治疗。这是首例报道的孕妇使用利托君后并发高褶虹膜型APAC的病例。这种情况在年轻成年人中罕见，难以诊断；然而，UBM可能会有很大帮助。在本病例中，透明晶状体摘除术取得了成功的结果。我们的病例表明，当高褶虹膜型APAC发生时，应注意药物关联。
