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Angle closure glaucoma associated with venlafaxine treatment
Author(s) -
TURCOTTE S,
FREDETTE MJ
Publication year - 2012
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2012.f033.x
Subject(s) - glaucoma , pilocarpine , medicine , ultrasound biomicroscopy , venlafaxine , gonioscopy , ophthalmology , intraocular pressure , anticholinergic , open angle glaucoma , anesthesia , antidepressant , psychiatry , hippocampus , epilepsy
Purpose Despite its very weak anticholinergic profile, there are few case reports linking venlafaxine treatment with angle closure glaucoma. One of the principal pathophysiological mechanisms suggested is through supraciliary effusions. Methods We report a case of an 86 year old patient who presented with progressive symptoms of angle closure glaucoma in her left eye. Venlafaxine treatment had been started one week prior to presentation. Intraocular pressures were initially 22 mmHg in the right eye and 59 mmHg in the left eye. Ultrasound biomicroscopy (UBM) and gonioscopic exams were performed to better identify the pathophysiologic mechanism of her glaucoma. Results Gonioscopy demonstrated a closed angle in the left eye and a narrow angle in the right eye. Venlafaxine was discontinued and an anti‐glaucomatous treatment was started. There was bilateral resistance to 2% pilocarpine at presentation which subsided 48 hours after venlafaxine cessation. UBM demonstrated a plateau iris configuration with absence of supraciliary effusions. Conclusion To our knowledge, this is the first case describing angle closure glaucoma associated with venlafaxine treatment, where there is a documented bilateral resistance to pilocarpine and an UBM demonstrating a plateau iris configuration with absence of ciliary body effusions. These findings suggest a mydriatic mechanism for our patient’s glaucoma. The weak anticholinergic properties and the noradrenergic effect associated with venlafaxine could precipitate angle closure glaucoma without supraciliary effusions in a patient who is at risk for this condition.