Arun Kumar Narayanaswamy, Meenal Antrolikar, Lingam Vijaya
Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India

Two patients presented with bilateral flat anterior chamber and high intraocular pressure several hours after uneventful cataract surgery in the fellow eye. The affected eye had undergone uneventful cataract surgery 6 weeks earlier. A single dose of oral acetazolamide 500 mg had been given as a routine preoperative measure prior to each surgery. Bilateral malignant glaucoma was suspected and intravenous mannitol and oral acetazolamide 250 mg 4 times daily were administered, along with topical steroids, β-blockers, and atropine. Ultrasound biomicroscopy showed choroidal effusion in both patients. Acetazolamide was withdrawn and complete resolution of choroidal effusion occurred rapidly. Bilateral secondary angle closure glaucoma can masquerade as bilateral malignant glaucoma and is usually a result of choroidal effusion secondary to an idiosyncratic response to a drug. In these patients, the instigating agent was acetazolamide. A non-invasive treatment approach of drug withdrawal and conservative management is usually effective.

Key words: Acetazolamide, Glaucoma

Asian J Ophthalmol. 2007;9:213-215.