J Korean Ophthalmol Soc > Volume 60(12); 2019 > Article
Journal of the Korean Ophthalmological Society 2019;60(12):1356-1362.
DOI: https://doi.org/10.3341/jkos.2019.60.12.1356    Published online December 15, 2019.
Report of Bilateral Acute Angle-closure Crisis Induced by Serotonin-norepinephrine Reuptake Inhibitors.
Jihyun Yoo, Roo Min Jun, Kyu Ryong Choi, Kyung Eun Han
The Institute of Ophthalmology and Optometry, Department of Ophthalmology, Ewha Womans University College of Medicine, Seoul, Korea. hkeoph@gmail.com
세로토닌-노르에피네프린 재흡수 억제제 복합 투여로 유발된 양안 급성폐쇄각녹내장 발작
윤지현 · 전루민 · 최규룡 · 한경은
이화여자대학교 의과대학 안과학교실 시과학연구센터
Correspondence:  Kyung Eun Han,
Email: hkeoph@gmail.com
Received: 4 July 2019   • Revised: 16 August 2019   • Accepted: 29 November 2019
Abstract
PURPOSE
This study reports a case of bilateral acute angle-closure crisis induced by two kinds of serotonin-norepinephrine reuptake inhibitors (SNRIs), duloxetine and tramadol. CASE SUMMARY: A 55-year-old female visited our clinic, complaining of bilateral visual impairment, ocular pain, and headache, which began 2 days after taking several drugs including duloxetine and tramadol for the purpose of back pain relief. On the day of the first visit, her uncorrected visual acuity was 0.04 in the right eye and 0.02 in the left eye, and the intraocular pressure (IOP) was 45 mmHg in the right eye and 51 mmHg in the left eye. The anterior chamber was shallow and the anterior chamber-angle was closed in both eyes on gonioscopy. There was mild nuclear sclerosis of both lenses. Assuming drug-induced bilateral acute angle-closure crisis, all medications were discontinued, and IOP-lowering agents were prescribed. The symptoms, visual acuity, and IOP improved; however, both anterior chambers were still shallow and the iridocorneal angle was still closed in both eyes. Laser iridotomy was tried in the right eye but failed because the pupils were not completely constricted, and iris bleeding occurred. Phacoemulsification and posterior chamber lens insertion were conducted in both eyes, and her visual acuity, IOP, anterior chamber depth, and iridocorneal angle have been stable at 9 months since her first visit. CONCLUSIONS: The combined administration of SNRI may cause bilateral acute angle-closure attacks.
Key Words: Antidepressive agent;Drug-induced angle closure glaucoma;Duloxetine hydrochloride;Serotonin-norepinephrine reuptake inhibitor;Tramadol


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