Angle closure glaucoma induced by ritodrine

Abstract

Angle closure glaucoma (ACG) is an ophthalmologic emergency that must be managed rapidly with a proper treatment modality. The potential complications of ACG are optic nerve injury, corneal edema and decreased visual acuity. The predisposing ocular anatomy is lens-iris apposition and a shallow anterior chamber. Emotional upset, dim illumination, female gender, childbirth, pituitary apoplexy and drugs (such as vasodilators, sympathomimetic, parasympatholytic and parasympathomimetic agents that are used systemically or topically) can cause ACG to occur in susceptible eyes (1,2). Case reportA 40-year-old primigravid woman at 26 weeks' gestation was admitted with the main complaint of back pain. Physical examination confirmed synchronized uterine contractions at 7-min intervals. Blood pressure and temperature measurements were within normal limits. The patient was hospitalized for the evaluation of preterm labor.In fetal biometry the estimated fetal weight was found to be 900 g at 26 weeks' gestation (50% percentile of Birthweight for gestational age), the biophysical profile was normal except for the amniotic fluid index, which was 5 cm. Umbilical and middle cerebral arterial Doppler studies were normal without findings of redistribution. Considering the diagnosis of preterm labor, which was accompanied by presumptive urinary infection, empiric ampicillin-sulbactam intravenous (i.v.) 1.5 g q.i.d. and ritodrine (i.v.) 3 mg/h were instituted. In addition, an initial intramuscular (i.m.) dose of betamethasone 10 mg was given. Eight hours after admission, the intensity and frequency of contractions decreased, together with relief of back pain. The patient subsequently complained of the acute onset of retro-orbital pain and blurred vision, and occipital headache. On ocular examination, her visual acuity was 20/400 in the right eye and 20/20 in the left eye. She did not have any ocular problems in her medical history. Applanation tonometry showed an intraocular pressure (IOP) of 62 mmHg (10-22) in the right eye and 40 mmHg (10-22) in the left eye. On slit lamp examina-tion, conjunctival hyperemia, corneal edema and a very shallow anterior chamber were found. The pupilla of the right eye was moderately dilated and nonreactive. The left anterior chamber was also shallow, but the pupilla was reactive. A closed angle in both eyes was detected on gonioscopy. There was no excavation of the optic nerve head on both sides, but the right one was more hyperemic. Considering that the diagnosis was acute ACG, intravenous magnesium sulfate was given instead of ritodrine. In order to lower the IOP, mannitol 20% i.v. 1 g/kg, oral acetazolamide 250 mg q.i.d., pilocarpine 2% topically q.i.d., and timolol topically 0.5% b.i.d. were instituted. After treatment, IOP were normalized and vision was improved. Iridotomies with an Nd : YAG laser was performed successfully on both eyes after resolution of corneal edema on the right eye. The antiglaucoma medications were ceased and she continued to use pilocarpine 2% topically once a day on both ey...

Angle closure glaucoma induced by ritodrine

“…Preterm delivery rate is approximately 11% in the USA and prematurity related to preterm delivery remains a leading cause of neonatal mortality and morbidity. The neonatal survival rate at 24 weeks' gestation was reported as 80%, while this figure was 94% at 29 weeks' gestation (1). The patient in our report was old, primiparous, and had a history of primary infertility for nine years.…”

“…We enjoyed reading the article from Guvendag Guven et al (1) who looked into angle closure glaucoma (ACG) in pregnancy and its relationship with the drug ritodrine. We appreciate their efforts and here we would like to share our alternative ideas regarding the suggestion that ritodrine was one of the causes of ACG.…”

“…Ritodrine was administrated with an initial dose of 50 mg/min and increased by 50 mg/min until contraction was ceased. The dose was increased to 3 mg/h as the maximum dose is 350 mg/min (1). It was higher than routine dosage.…”

Acute Primary Angle Closure Caused by Plateau Iris After Ritodrine Use in a Primigravid Woman Successfully Treated With Clear-Lens Extraction: A Case Report

“…This patient developed APAC the day after administration of the β2 agonist ritodrine for threatened premature labor. The occurrence of APAC after the use of ritodrine has been previously reported in one case with a shallow anterior chamber in a pregnant woman [5]. Ritodrine does not induce mydriasis, leading the authors to consider that bed rest in a dark hospital room and the emotional stress of threatened premature labor induced mydriasis, resulting in APAC.…”

Reply regarding “Angle closure glaucoma induced by ritodrine”

“…The best treatment strategy for angle closure glaucoma cases in pregnancy is not well described, as only a few cases have been reported until now 10, 11. We preferred glaucoma medications as an initial management instead of argon laser peripheral iridoplasty.…”