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Ribeiro M, Barbosa-Breda J, Gonçalves F, Faria Pereira A, Falcão-Reis F, Alves F, E Silva S, B Melo A. [Evaluation of the Manchester Triage System in Patients with Acute Primary Angle Closure Attack: A Retrospective Study]. ACTA MEDICA PORT 2023; 36:698-705. [PMID: 36929920 DOI: 10.20344/amp.19170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 01/16/2023] [Indexed: 03/18/2023]
Abstract
INTRODUCTION Acute primary angle closure attack is an ophthalmological emergency. The aim of this study was to describe the cases diagnosed in the Emergency Department, by correlating the initial complaint with the Manchester triage level and ultimately the time needed until ophthalmological evaluation and iridotomy. MATERIAL AND METHODS Retrospective analysis of the electronic medical records of patients with acute primary angle closure attack that attended the Ophthalmology Emergency Department of our tertiary center between January 2010 and December 2020. Overall, 2228 Emergency Department episodes coded with the diagnoses glaucoma or ocular hypertension were retrieved, followed by screening of each episode for correct identification of true acute primary angle closure attacks. Clinical data was gathered, including Manchester triage level, presenting complaint, intraocular pressure at presentation, first medical specialty that observed the patient, time until observation by Ophthalmology and time until laser iridotomy. RESULTS Among the 120 patients identified, 84 (70%) were female and the mean age was 68 ± 12 years. Mean intraocular pressure at admission was 53.4 ± 12.4 mmHg, and 9.2% of patients presented only non-ocular complaints, while 9.2% presented mixed complaints (ocular and non-ocular). Most patients (68.1%) with only non-ocular or mixed complaints were triaged to a non-ophthalmologist (p < 0.001). Concerning the triage system, at admission, most patients (66.7%) were labelled yellow (urgent), while 9.2% and none were labelled as orange (very urgent) or red (emergent), respectively. Most patients (83.3%) were directly sent to Ophthalmology (properly triaged), while the remaining were incorrectly assigned to a non-ophthalmologist. Median time until observation by Ophthalmology was 49 minutes in the properly triaged group (min. 15, max. 404), while it was 288 minutes (min. 45, max. 871) in those who were incorrectly triaged (p < 0.001). Likewise, median time until treatment with laser iridotomy was 203 minutes in the properly triaged group (min. 22, max. 1440) and 353 minutes in the incorrectly triaged group (min.112, max. 947) (p < 0.001). CONCLUSION Most patients with acute primary angle closure attack were not properly triaged according to the level of the Manchester triage system. There was a significant delay in the diagnosis and treatment of those patients who were first assigned to non-ophthalmologists. There is a need to raise awareness regarding the presenting signs and symptoms of an acute primary angle closure attack in order to avoid preventable vision loss.
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Affiliation(s)
- Margarida Ribeiro
- Ophthalmology. Centro Hospitalar e Universitário de São João. Porto; Biomedicine Department. Unit of Farmacology and Therapeutics. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | - João Barbosa-Breda
- Ophthalmology Service. Centro Hospitalar e Universitário de São João. Porto; UnIC@RISE. Departmento of Surgery and Phisiology. Faculdade de Medicina. Universidade do Porto. Portugal; KU Leuven. Research Group Ophthalmology. Department of Neurosciences. Leuven. Belgium
| | | | - Ana Faria Pereira
- Ophthalmology Service. Centro Hospitalar e Universitário de São João. Porto. Portugal
| | - Fernando Falcão-Reis
- Ophthalmology Service. Centro Hospitalar e Universitário de São João. Porto; Department of Surgery and Phisiology. Faculdade de Medicina. Universidade do Porto. Portugal
| | - Flávio Alves
- Ophthalmology Service. Centro Hospitalar e Universitário de São João. Porto. Portugal
| | - Sérgio E Silva
- Ophthalmology Service. Centro Hospitalar e Universitário de São João. Porto; Department of Surgery and Phisiology. Faculdade de Medicina. Universidade do Porto. Portugal
| | - António B Melo
- Ophthalmology Service. Centro Hospitalar e Universitário de São João. Porto; Department of Surgery and Phisiology. Faculdade de Medicina. Universidade do Porto. Portugal
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Na KI, Park SP. Association of Drugs With Acute Angle Closure. JAMA Ophthalmol 2022; 140:1055-1063. [PMID: 36136326 PMCID: PMC9501771 DOI: 10.1001/jamaophthalmol.2022.3723] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/31/2022] [Indexed: 12/15/2022]
Abstract
Importance Acute angle-closure (AAC) glaucoma is a sight-threatening disease and can reportedly occur in association with various drugs. Objective To identify drugs that are associated with AAC glaucoma occurrence and evaluate the risk of AAC associated with each drug. Design, Setting, and Participants A case-crossover study was conducted using the Health Insurance Review and Assessment Service database, which contains medical information of the entire Korean population. Patients who were first diagnosed with AAC and treated between 2013 and 2019 were identified using diagnostic and procedure codes. All drugs that the study participants were prescribed as well as prescription dates during the period of 1 to 180 days before the onset of AAC were extracted from the database. For each patient, 1 to 30 days before onset was considered the hazard period, and 91 to 180 days before AAC onset was considered the control period. Main Outcomes and Measures Drugs associated with AAC and odds (calculated as odds ratios [ORs] with 95% CIs) of AAC development associated with each identified drug. Results A total of 949 drugs that were prescribed to 13 531 patients with AAC (mean [SD] age, 66.8 [10.6] years; 9585 [70.8%] female) during the period of 1 to 180 days before the onset of AAC were analyzed. A total of 61 drugs were found to be associated with AAC, among which sumatriptan (OR, 12.60 [95% CI, 4.13-38.44]) was associated with the highest odds of AAC development, followed by topiramate (OR, 5.10 [95% CI, 2.22-11.70]) and duloxetine (OR, 4.04 [95% CI, 2.95-5.54]). The median (IQR) period from prescription of the drug to the onset of AAC for the 61 drugs was 11.9 days (10.9-12.8). A number of drugs not previously considered to be associated with AAC, including lactulose (OR, 2.81 [95% CI, 1.72-4.61]) and metoclopramide (OR, 2.52 [95% CI, 1.95-3.25]), were identified. Conclusions and Relevance Results of this case-crossover study suggest a need to consider AAC risk in patients taking any of the 61 drugs found to be associated with AAC.
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Affiliation(s)
- Kyeong Ik Na
- Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Sung Pyo Park
- Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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Kim WJ, Li J, Oh IS, Song I, Lee E, Namkoong K, Shin JY. Benzodiazepine Use and Risk of Acute Angle-Closure Glaucoma: A Population-Based Case-Crossover Study. Drug Saf 2021; 43:539-547. [PMID: 32034700 DOI: 10.1007/s40264-020-00914-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Theoretically, benzodiazepines (BZDs) can narrow the iridocorneal angle and induce acute angle-closure glaucoma (AACG). However, little evidence exists regarding this association. OBJECTIVE The objective of this study was to assess whether the use of BZDs is associated with the risk of AACG. METHODS We conducted a population-based case-crossover study using the nationwide claims database of the National Health Insurance Service in Korea. Patients with newly diagnosed AACG-between 1 January 2013 and 31 December 2016-who had received at least one BZD prescription prior to AACG diagnosis were enrolled. The date of AACG diagnosis was set as the index date. We assessed BZD use by each patient during a 30-day case period prior to the index date and three consecutive control periods that preceded this date. We used conditional logistic regression that adjusted for concomitant medications to determine the odds ratio for the use of BZDs in the case period compared with that in the control period in patients with incident AACG. RESULTS Of the 11,093 patients with incident AACG, 6709 received a prescription for BZD prior to diagnosis. BZD use was associated with an increased risk of AACG [adjusted odds ratio (aOR) = 1.40; 95% confidence interval (CI) 1.27-1.54]. AACG risk was similar for short-acting (aOR = 1.40, 95% CI 1.24-1.57) and long-acting BZDs (aOR = 1.33, 95% CI 1.18-1.50). CONCLUSION We found that BZD use was associated with AACG risk in the Korean population. Clinicians should carefully monitor the occurrence of visual disturbance in BZD-treated patients.
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Affiliation(s)
- Woo Jung Kim
- Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Gyeonggi-do, Republic of Korea.,Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Junqing Li
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do, Republic of Korea
| | - In-Sun Oh
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do, Republic of Korea
| | - Inmyung Song
- Department of Health Administration, Kongju National University College of Nursing and Health, Gongju-si, Chungcheongnam-do, Republic of Korea
| | - Eun Lee
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Psychiatry, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kee Namkoong
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Psychiatry, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do, Republic of Korea.
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The Challenge of Managing Bilateral Acute Angle-closure Glaucoma in the Presence of Active SARS-CoV-2 Infection. J Glaucoma 2021; 30:e50-e53. [PMID: 33337718 DOI: 10.1097/ijg.0000000000001763] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 11/21/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To report a case of bilateral acute angle-closure glaucoma associated with hyponatremia in the setting of chlorthalidone use and SARS-CoV-2 infection, and to demonstrate the challenges of managing this patient given her infectious status. METHODS This was a case report. CASE A 65-year-old woman taking chlorthalidone for hypertension presented to the emergency room with headache, pain, and blurry vision in both eyes and was found to be in bilateral acute angle closure. On laboratory investigation, she was severely hyponatremic and also tested positive for SARS-CoV-2. B-scan ultrasound demonstrated an apparent supraciliary effusion in the right eye. Following stabilization of her intraocular pressures with medical management, she ultimately underwent cataract extraction with iridectomies and goniosynechiolysis in both eyes. CONCLUSIONS We report a rare case of bilateral acute angle-closure glaucoma associated with hyponatremia. Chlorthalidone use and perhaps SARS-CoV-2 infection may have contributed to this electrolyte abnormality and unique clinical presentation. In addition, we discuss the challenges of managing this complex patient with active SARS-CoV-2 infection during the pandemic.
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Abstract
Glaucoma is seen as a heterogeneous group of diseases characterized by optical neuropathy with associated visual field loss; one of the main risk factors for its development is increased intraocular pressure (IOP). In the case of drug-induced glaucoma (DIG), patients develop elevated IOP, optic neuropathy and visual field defects associated with the use of certain drugs. Corticosteroids are one of the most well-known classes of drugs that can cause an increase in IOP through the open-angle mechanism. Drug-induced glaucoma, which develops similarly to open-angle glaucoma, can also be caused by some non-steroidal anti-inflammatory agents, antibodies to the endothelial growth factor, etc. Classes of drugs that can cause angle-closure glaucoma include topical anticholinergic or sympathomimetic drops, tricyclic antidepressants, monoamine oxidase inhibitors, antihistamines, antiparkinsonian drugs, antipsychotic drugs, antispasmodics. Products containing sulfa group drugs can cause DIG due to a different closing angle mechanism involving a forward rotation of the ciliary body. It is important for medical practitioners to be aware of this unwanted drug reaction in order to prevent, detect and treat DIG. In the case of drug-induced increase in IOP, if the underlying disease allows discontinuation of drugs, this measure usually leads to normalization of IOP. In cases when the patient's IOP does not normalize after discontinuation of steroids or when they must continue to take corticosteroids, the administration of topical drugs for the treatment of glaucoma should be considered.
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Affiliation(s)
- O D Ostroumova
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - E V Shikh
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - E V Rebrova
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | | | - L K Moshetova
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
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Park MY, Kim WJ, Lee E, Kim C, Son SJ, Yoon JS, Kim W, Namkoong K. Association between use of benzodiazepines and occurrence of acute angle-closure glaucoma in the elderly: A population-based study. J Psychosom Res 2019; 122:1-5. [PMID: 31126405 DOI: 10.1016/j.jpsychores.2019.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 04/22/2019] [Accepted: 04/25/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Because benzodiazepines (BZDs) can affect pupillae muscles, their use could be a risk factor for acute angle-closure glaucoma (AACG), which is an ophthalmic emergency. However, there is no research evidence for the association between BZDs and AACG, except two case reports. We aimed to investigate whether BZDs increase the risk of AACG in a geriatric population. METHODS We performed a case-control study using a geriatric cohort from the National Health Insurance database (2002-2013) in Korea. Case subjects (n = 1117) were patients diagnosed with AACG. Controls, people who have not been diagnosed with AACG, were randomly matched with the case according to age, sex, and index year (n = 4468). To examine the risk of BZD use for AACG, we performed conditional logistic regression analyses with potential confounders including comorbidities and concomitant medication. RESULTS The use of BZD within 30 days was not significantly associated with AACG risk (adjusted odds ratio [aOR] = 1.14, 95% confidence interval [CI] = 0.94-1.37). Further analyses showed that, compared with non-use of BZD, new BZD use had a significantly increased risk for the development of AACG (aOR = 1.62, 95% CI = 1.09-2.37). The risk was higher in the new BZD users exposed within 7 days (aOR = 3.09, 95% CI = 1.58-5.88). CONCLUSION We found that BZDs increase the risk of AACG at the beginning of its use among the Korean elderly. Clinicians should monitor visual disturbance in the elderly during the early period after prescription of BZD.
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Affiliation(s)
- Man Young Park
- Future Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Woo Jung Kim
- Department of Psychiatry, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Eun Lee
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Changsoo Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Joon Son
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jin Sook Yoon
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woojae Kim
- Department of Public Health and Medical Administration, Dongyang University, Yeongju, Republic of Korea
| | - Kee Namkoong
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
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Abstract
Numerous systemically used drugs are involved in drug-induced glaucoma. Most reported cases of non-steroidal drug-induced glaucoma are closed-angle glaucoma (CAG). Indeed, many routinely used drugs that have sympathomimetic or parasympatholytic properties can cause pupillary block CAG in individuals with narrow iridocorneal angle. The resulting acute glaucoma occurs much more commonly unilaterally and only rarely bilaterally. CAG secondary to sulfa drugs is a bilateral non-pupillary block type and is due to forward movement of iris-lens diaphragm, which occurs in individuals with narrow or open iridocorneal angle. A few agents, including antineoplastics, may induce open-angle glaucoma. In conclusion, the majority of cases with glaucoma secondary to non-steroidal medications are of the pupillary block closed-angle type and preventable if the at-risk patients are recognized and treated prophylactically.
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Affiliation(s)
- M R Razeghinejad
- Glaucoma Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, PA, USA.
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Osman EA, Al-Saleh AA. Immediate changes in pupil size following Laser in situ keratomileusis (LASIK): Pupillometry study. Saudi J Ophthalmol 2010; 24:139-41. [DOI: 10.1016/j.sjopt.2010.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 06/07/2010] [Accepted: 06/08/2010] [Indexed: 10/19/2022] Open
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Salim S, Shields MB. Glaucoma and systemic diseases. Surv Ophthalmol 2010; 55:64-77. [PMID: 19833365 DOI: 10.1016/j.survophthal.2009.03.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Accepted: 03/26/2009] [Indexed: 01/24/2023]
Abstract
Glaucoma management may be extremely challenging, especially in elderly patients who have a variety of systemic diseases and take multiple medications. We obtained a comprehensive medical history in patients with primary open-angle glaucoma to determine which systemic diseases are most prevalent and which systemic medications are most commonly used. We have also reviewed the literature that addresses how these concomitant diseases and medical treatments influence the management of glaucoma. Knowledge of systemic diseases and potential drug interactions, especially between various systemic and glaucoma medications, is important for the safe management of glaucoma patients.
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Affiliation(s)
- Sarwat Salim
- Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Croos R, Thirumalai S, Hassan S, Davis JDR. Citalopram associated with acute angle-closure glaucoma: case report. BMC Ophthalmol 2005; 5:23. [PMID: 16202173 PMCID: PMC1262727 DOI: 10.1186/1471-2415-5-23] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2005] [Accepted: 10/04/2005] [Indexed: 12/03/2022] Open
Abstract
Background Acute angle-closure glaucoma is a rare complication in patients receiving anti-depressant treatment. In the following case, we report the development of acute angle closure glaucoma in a patient who overdosed on Citalopram, an antidepressant, and discuss the possible etiological mechanisms for the condition. Case presentation We report a 54 year old, Caucasian lady, with depression and alcohol dependence syndrome, who developed acute angle-closure glaucoma after an overdose of Citalopram, along with alcohol. She was treated with medications and had bilateral Yag laser iridotomies to correct the glaucoma and has made complete recovery. In this case, the underlying cause for glaucoma appears to be related to the ingestion of Citalopram. Conclusion The patho-physiological basis for acute angle closure glaucoma in relation to antidepressant medications remains unclear. The authors suggest Citalopram may have a direct action on the Iris or Ciliary body muscle through serotonergic or anti-cholinergic mechanisms or both. This case highlights the importance of the awareness of the underlying risks, which may predispose an individual to develop acute angle-closure glaucoma, and reminds the clinicians the significance of history taking and examination of the eye before and after starting anti-depressants. This area needs to be further researched.
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Affiliation(s)
- Robert Croos
- Department of Psychiatry, Prospect Park Hospital, Reading, RG30 4EJ, UK
| | - Srinivasa Thirumalai
- Department of Psychiatry, Marlborough House Regional Secure Unit, Milton Keynes Hospital Site, Eaglestone, Standing Way, Milton Keynes, MK6 5NG, UK
| | - Sabit Hassan
- Department of Ophthalmology, Royal Berkshire Hospital, Reading, RG1 5AN, UK
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Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2001; 10:69-84. [PMID: 11417072 DOI: 10.1002/pds.546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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