Kudasiewicz-Kardaszewska Agnieszka, Ozimek Małgorzata, Urbański Tomasz, Cisiecki Sławomir
Prof. Zagórski Eye Surgery Center, OCHO Medical Group, Batorego 88, 33-300 Nowy Sącz, Poland.
Prof. Zagórski Eye Surgery Center, OCHO Medical Group, Kasztanowa 6, 24-150 Nałęczów, Poland.
Life (Basel). 2025 May 19;15(5):811. doi: 10.3390/life15050811.
This case report presents an unusual instance of bilateral choroidal effusion following the oral administration of acetazolamide for the treatment of pseudophakic cystoid macular edema (PCME).
An 87-year-old Caucasian man experienced sudden, painless vision loss in both eyes several days after beginning treatment for PCME in his left eye. He had undergone uncomplicated cataract surgery in both eyes two months earlier. The treatment regimen included oral acetazolamide (250 mg twice daily) and topical pranoprofen, a nonsteroidal anti-inflammatory drug (NSAID). One week after the initiation of acetazolamide treatment, the patient suffered a marked decline in visual acuity. Bilateral choroidal effusion was diagnosed. Prompt discontinuation of acetazolamide and initiation of topical dexamethasone (1% hourly) and atropine (1% twice daily) resulted in rapid clinical improvement.
Carbonic anhydrase inhibitors (CAIs) such as acetazolamide, although commonly used to manage intraocular pressure, can cause choroidal effusion-a rare but potentially sight-threatening complication. Ophthalmologists should exercise caution, particularly in elderly patients, and be alert to early signs of this adverse effect. Early diagnosis and prompt management are essential to prevent permanent visual damage. To our knowledge, this is the first reported case of bilateral choroidal detachment associated with acetazolamide in the context of PCME.
本病例报告呈现了口服乙酰唑胺治疗人工晶状体眼黄斑囊样水肿（PCME）后出现双侧脉络膜积液的罕见情况。
一名87岁的白种男性在左眼开始治疗PCME几天后，双眼突然出现无痛性视力丧失。两个月前他双眼接受了无并发症的白内障手术。治疗方案包括口服乙酰唑胺（每日两次，每次250毫克）和局部使用非甾体抗炎药（NSAID）普拉洛芬。乙酰唑胺治疗开始一周后，患者视力显著下降。诊断为双侧脉络膜积液。立即停用乙酰唑胺，并开始局部使用地塞米松（每小时1%）和阿托品（每日两次，每次1%），临床症状迅速改善。
乙酰唑胺等碳酸酐酶抑制剂（CAIs）虽然常用于控制眼压，但可导致脉络膜积液——一种罕见但可能威胁视力的并发症。眼科医生应谨慎行事，尤其是在老年患者中，并警惕这种不良反应的早期迹象。早期诊断和及时处理对于预防永久性视力损害至关重要。据我们所知，这是PCME背景下与乙酰唑胺相关的双侧脉络膜脱离的首例报道病例。
