Moshirfar Majid, Moin Kayvon A, Jaafar Muhammed, Han Kenneth, Omidvarnia Soroush, Hoopes Phillip C
Hoopes Vision Research Center, Hoopes Vision, Draper, UT, USA.
John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA.
Case Rep Ophthalmol. 2024 Jul 18;15(1):565-571. doi: 10.1159/000540080. eCollection 2024 Jan-Dec.
Amphetamine-based medications such as Adderall, used for the treatment of attention deficit-hyperactivity disorder (ADHD), may theoretically elicit angle closure through their adrenergic mechanisms. The relationship between the use of implantable collamer lenses (ICLs) and angle closure has been extensively investigated based on appropriate vault and lens sizing and postoperative changes in the anterior chamber angle (ACA) and corneal morphology. This case reflects a synergistic impact from both Adderall use and ICL implantation for the proposed mechanism of angle closure.
A 36-year-old myopic female with ADHD controlled with Adderall underwent toric ICL implantation in the right eye after undergoing preoperative laser peripheral iridotomy. Shortly after, the patient developed episodic angle closure in the right eye, with episodes mainly occurring after taking an additional dose of Adderall in a dimly lit environment. The patient later had an ICL exchange with a smaller sized EVO+ toric ICL in the right eye and remained asymptomatic after.
Additive mechanisms from both the ICL and Adderall were present in our patient. The ICL caused crowding of the ACA through a pseudophacomorphic mechanism, and the Adderall caused increased iridotrabecular contact secondary to pharmacologic mydriasis. This resulted in episodic angle closure with subsequent spikes in the intraocular pressure. There are no current reports or studies in the current literature describing the combined mechanisms of ICL implantation and Adderall use in the potential development of angle closure. Further studies may be done to assess interactions of such medications in patients after ICL implantation.
用于治疗注意力缺陷多动障碍（ADHD）的基于苯丙胺的药物，如阿得拉，理论上可能通过其肾上腺素能机制引发闭角型青光眼。基于合适的房角深度和晶状体尺寸以及前房角（ACA）和角膜形态的术后变化，可植入式胶原晶状体（ICL）的使用与闭角型青光眼之间的关系已得到广泛研究。本病例反映了阿得拉的使用和ICL植入对所提出的闭角型青光眼机制的协同影响。
一名36岁患有ADHD且通过阿得拉控制病情的近视女性，在接受术前激光周边虹膜切开术后，右眼植入了散光型ICL。术后不久，患者右眼出现发作性闭角型青光眼，发作主要发生在昏暗环境中额外服用一剂阿得拉之后。该患者后来右眼进行了ICL置换，植入了尺寸更小的EVO+散光型ICL，此后一直无症状。
我们的患者存在ICL和阿得拉的叠加机制。ICL通过假晶状体形态改变机制导致ACA拥挤，而阿得拉因药物性散瞳导致虹膜小梁接触增加。这导致了发作性闭角型青光眼并随后眼压升高。目前文献中尚无关于ICL植入和阿得拉使用在闭角型青光眼潜在发生中的联合机制的报道或研究。可能需要进一步研究来评估此类药物在ICL植入术后患者中的相互作用。
