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Multiple toxicities: case report In a retrospective study of seven patients with inherited retinal dystrophies treated with topical brinzolamide at university in USA between 2008 and 2015, a boy in first decade of his life was described, who developed tachyphylaxis and acute angle-closure glaucoma following off-label treatment with brinzolamide for X-linked retinoschisis. Additionally, he developed nausea and vomiting during treatment with acetazolamide for X-linked retinoschisis [dose not stated]. The boy presented with a decrease in the vision at the age of 7 years. His family history was significant for decreased vision. After further examination, he was diagnosed with X-linked retinoschisis. Hence, new prescription glasses were given. Subsequently, in July 2012, he started receiving off-label brinzolamide eye drops twice daily in the right eye, followed by thrice daily in both the eyes. At an interval visit in Feb 2014, his vision remained stable. In September 2014, he complained of blurred vision in the left eye. An optical coherence tomography showed a stable vision, but a slight increase in central macular thickness (CMT) was noted. Hence, his parents were advised to comply with brinzolamide drops. In December 2014 (approximately 2.5 years after initiation of brinzolamide), his vision in the left eye decreased with further increase in CMT. Hence, he was suspected to have tachyphylaxis. Therefore, brinzolamide administration in the left eye was stopped for one month. In March 2015, he presented with headaches. The optical coherence tomography revealed a significant increase in CMT in the left eye and increased intraocular pressure in the setting of a shallow anterior chamber. He was diagnosed with acute angle-closure glaucoma with recurrence of cystoid macular oedema in the left eye, which was caused by drug-induced ciliary body rotation. His best-corrected visual acuity score was 20/60 OD and 20/300 OS. Afterwards, he was treated with oral acetazolamide, but within 24h of administration, he developed nausea and vomiting. Hence, the boy’s treatment with acetazolamide was switched back to brinzolamide. Six weeks later (in April 2015), his visual acuity in the left eye became stable, along with normalisation of intraocular pressure and slight improvement in schisis. Five months later, CMT and visual acuity in the left eye resolved to pre-discontinuation levels [not all outcomes stated]. Scruggs BA, et al. Efficacy of topical brinzolamide in children with retinal dystrophies. Ophthalmic Genetics 40: 350-358, No. 4, 09 Sep 2019. Available from: URL: http:// 803444615 doi.org/10.1080/13816810.2019.1660381

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Reactions 11 Jan 2020 No. 1786