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Effects of medications in refractive surgery: about a case

Poster Details

First Author: R.Massa PORTUGAL

Co Author(s):    C. Vale   M. Lume   R. Salgado   M. Brochado     

Abstract Details



Purpose:

To present a case report of the evolution of corneal endothelium after an episode of angle-closure glaucoma induced by topiramate in a patient with Artisan® phakic intraocular lenses for high myopia.

Setting:

Ophthalmology Department of Centro Hospitalar do Porto - Hospital de Santo António in Oporto, Portugal.

Methods:

Patient's data including clinical ophthalmologic evaluations complemented with ultrasound biomicroscopy, specular microscopy and corneal tomography.

Results:

A 42-year-old woman with high myopia corrected with the implantation of Artisan® phakic intraocular lenses seven years before was admitted to the Emergency Department with ocular pain and decreased visual acuity. The patient had an uncorrected visual acuity of counting fingers in the right eye (RE) and 0.3 in her left eye (LE). Biomicroscopy showed conjunctival injection, corneal edema, appositional closure of the irido-corneal angle and a shallow anterior chamber, especially in the RE Intraocular pressure was 45/34 mmHg. The patient reported a history of migraine recently medicated with topiramate. Antiglaucoma therapy was initiated and topiramate was stopped. Ultrassound biomicroscopy revealed ciliary edema especially in the RE with an anterior chamber of 2.22 mm in the RE and of 2.43 in the LE. Specular microscopy showed 329 cells/mm2 in the RE and 1876 cells/mm2 in the LE. An explantation of Artisan® phakic lenses with phacoemulsification and posterior chamber lenses implantation was performed. The patient was observed regularly to detect additional corneal decompensation. Seven years later, the patient has an endothelial cell count of 350cells/mm2 in the RE and of 2000 cells/mm2 in the LE with an anterior chamber depth of 3.20 in the RE and of 3.32 in the LE.

Conclusions:

Phakic lenses implantation requires a meticulous preoperative study as well as a long-term 'follow-up' to detect their possible complications. Special attention should be given not only to anatomical characteristics but also to systemic and pharmacological history. This case is an example of the disastrous consequences of some medications in the outcomes of refractive surgery. FINANCIAL INTEREST: NONE

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