Posters

Glaucoma secondary to antidepressive treatment

Poster Details

First Author: E. Escobar Martin SPAIN

Co Author(s):    H. Santiago Balsera   G. Karla Paola   L. Modamio Gardeta   C. del Prado Sanchez   J. Ferreiro Lopez   C. Carrasco Font     

Abstract Details

Purpose:

To describe the case of a young male patient who developed primary angle-closure glaucoma after treatment with antidepressive drugs.

Setting:

Iatrogenic glaucoma secondary to medications should be considered and can be avoidable. Patients with a narrow irido-corneal angle are at high risk.

Methods:

The patient is a 38 years old men with family history of glaucoma who first came to consultation on September 2009 complaining about photopsia. Snellen VA was 1,0 on both eyes. The anterior pole was examinated as normal with slit-lamp, intraocular pressure (IOP) was 24 on right eye (RE) and 19 on the left eye (LE). A corneal pachimetry was performed showing 625μm on the RE and 626μm on the LE. Optic nerves has a cup-disc ratio of 0,2. Humphrey visual field was revealed as normal. OCT-cirrus RNFL measurement were RE 116μm and LE 97μm.

Results:

The patient was missed for follow up until 2015 complaining about photopsias and blur vision. Snellen VA was O,63 on the RE and 0,8 on LE. Intraocular pressure was 45 and 35 mmHg. Fundus examination showed glaucomatous cupping on the RE wit a cup-disc ratio of 0,7 RE and 0,5 LE. Fisual field showed an inferior arciform defect -16,85dB and a Grade 0/1 angle was demonstrated by gonioscopy. RNFL analysis showed a decrease RNFL on the RE (74 μm). The patient revealed that had treatment with fluoxetine, a selective serotonin reuptake inhibitors (SSRI) for a year. Treatment with a prostaglandin analogue and iridotomy was performed.

Conclusions:

The patient presented a high paquimetry leading to an overestimation of IOP, with normal optic disc and visual field. In that context annual consultation was considered. The missing of follow up during 4 years showed changes on the clinical situation and new treatment was established resulting in closed-angle glaucoma with optic nerve damage on Re. Patients under treatment with SSRI may be at risk of primary angle-closure glaucoma due to anticholinergic effect causing mydriasis.

Financial Disclosure:

NONE