Bilateral, Simultaneous, Acute Angle Closure Glaucoma in Pseudophakia Induced by Chlorthalidone

Area of Science:

• Ophthalmology
• Pharmacology

Background:

• Angle closure glaucoma is a serious condition affecting vision.
• Pseudophakia, the presence of an intraocular lens, can alter ocular anatomy.
• Uveal effusions are fluid collections within the uvea, potentially impacting intraocular pressure.

Purpose of the Study:

• To report two cases of acute, bilateral, and simultaneous angle closure glaucoma.
• To investigate the link between chlorthalidone administration and secondary angle closure glaucoma in pseudophakia.
• To elucidate the mechanism of drug-induced glaucoma in these specific cases.

Main Methods:

• Case report of two patients presenting with acute visual decline after chlorthalidone intake.
• Ophthalmic examinations including gonioscopy.
• Ultrasonographic studies to assess choroidal and ciliochoroidal structures.

Main Results:

• Both patients developed bilateral shallow anterior chambers and elevated intraocular pressure (IOP) shortly after starting chlorthalidone.
• Gonioscopy revealed appositional angle closure.
• Ultrasonography demonstrated ciliochoroidal detachment.

Conclusions:

• Chlorthalidone can induce angle closure glaucoma in pseudophakic eyes through an idiosyncratic reaction.
• The mechanism involves ciliochoroidal detachment, ciliary body edema, and rotation, not osmotic changes in the lens.
• Discontinuation of chlorthalidone and appropriate medical management successfully reversed the glaucoma.