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Acute onset angle-closure glaucoma: case report A 25-year-old man developed acute onset angle-close glaucoma following administration of phentermine/topiramate for losing the weight. The man presented with acutely decreased visual acuity in both the eyes. He reported waking-up the same morning with normal visual acuity, which progressively worsened to the extent that he was unable to work. He had no additional symptoms, except for mild tearing. His visual acuity improved with a -10 diopter lens; however, the intraocular pressure was elevated to between 30–40 mm-Hg in both eyes. He was sent to the emergency department and was evacuated. His medical history included hypertension and asthma. Concomitant medications included salbutamol [albuterol], losartan and fluticasone propionate. Upon examination, the visual acuity was 20/400 OU (with prescription lenses, –2.50 + 1.00 × 081 OS and –2.75 + 1.00 × 090 OD). His bestcorrected visual acuity was 20/25 OU (manifest refraction, –10.75 + 0.25 × 050 OS and –12.00 + 1.75 × 097 OD). His intraocular pressure was 19 in both eyes. A slit-lamp examination demonstrated temporal chemosis and mild diffuse vasodilation, shallow anterior chambers, clear corneas and clear lenses in both the eyes. An ultrasound biomicroscopy revealed anterior uveal effusion (arrowhead) and oedema of the ciliary body. A differential diagnosis of drug-induced angle-closure glaucoma was made. His medication history revealed ingestion of 2 extended release pills (1 dose) of phentermine/topiramate [Qsymia] 3.75mg/23mg for weight loss, one week prior to presentation. Subsequently, he had developed blurry vision and elevated intraocular pressures. This history and current clinical findings were suggestive of phentermine/topiramate-induced angleclosure glaucoma. The man was advised to discontinue phentermine/ topiramate. At 2-week follow-up, his visual acuity returned to 20/20 in both eyes with his old prescription lens. Ultrasonographic biomicroscopy revealed resolution of anterior choroidal effusions. Author comment: "Since being approved by the Food and Drug Administration for weight loss in 2012, one other case of presumed phentermine-topiramate–induced glaucoma has been reported in the literature". "Drug-induced secondary angle-closure glaucoma is an emergency that necessitates cessation of the offending drug. With this patient, the intraocular pressure spontaneously decreased to normal within 24 hours without any interventions." Chen EL, et al. Acute Onset of Blurry Vision in a Young Man. JAMA Ophthalmology 137: 1205-1206, No. 10, Oct 2019. Available from: URL: http:// 803437500 doi.org/10.1001/jamaophthalmol.2019.3058 - USA

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Reactions 7 Dec 2019 No. 1782