Kaisari Eirini, Abouzeid Hana, Magnin Laurent, Boeuf Melanie, Gkaragkani Evangelia, Schalenbourg Ann, Wolfensberger Thomas J, Kaeser Pierre-François
Department of Ophthalmology, Jules-Gonin Eye Hospital, University of Lausanne, Switzerland.
Ophthalmology, AZ Ophtalmologie, Geneva, Switzerland.
Klin Monbl Augenheilkd. 2024 Apr;241(4):554-558. doi: 10.1055/a-2244-6160. Epub 2024 Apr 23.
We report the case of a 32-year-old male who presented with an acute myopic shift as a result of uveal effusion following a single administration of 250 mg acetazolamide. The drug was discontinued and following cycloplegia and topical steroid therapy, we observed progressive deepening of the anterior chamber, reopening of the iridocorneal angle, and complete resolution of the myopic shift after 5 days. A literature review since 1956 identified 23 cases, including ours, which developed a myopic shift after a median time of 24 h (3 - 24) following a median dose of 500 mg (125 - 1000) acetazolamide, with about a third complicated by angle closure ocular hypertension. This presumed idiosyncratic reaction can occur without prior drug exposure and independent of the phakic status. Treatment options include systematic drug withdrawal associated with cycloplegia, anti-glaucomatous agents, and/or corticosteroids. Full recovery is achieved within about 5 days (2 - 14). Given the widespread use of acetazolamide, awareness of this idiosyncratic reaction is crucial to avoid complications of acute angle-closure glaucoma.
我们报告了一例32岁男性病例，该患者单次服用250mg乙酰唑胺后因葡萄膜渗漏出现急性近视性移位。停用该药物后，在睫状肌麻痹和局部类固醇治疗后，我们观察到前房逐渐加深，虹膜角膜角重新开放，近视性移位在5天后完全消退。自1956年以来的文献综述确定了23例病例，包括我们的病例，这些病例在中位剂量500mg（125-1000）乙酰唑胺后中位时间24小时（3-24）出现近视性移位，约三分之一合并闭角型青光眼高眼压。这种推测的特异反应可在无先前药物暴露的情况下发生，且与晶状体状态无关。治疗选择包括与睫状肌麻痹、抗青光眼药物和/或皮质类固醇相关的系统性停药。约5天（2-14）内可实现完全恢复。鉴于乙酰唑胺的广泛使用，认识到这种特异反应对于避免急性闭角型青光眼的并发症至关重要。
