Bilateral Serous Macular Detachment After Attempted Suicide with Pregabalin

Abstract

A 24-year-old female presented with bilateral vision loss following attempted suicide with pregabalin. Her best-corrected visual acuity (BCVA) was 20/40 in the right eye and 20/50 in the left eye. The bilateral visual disturbance was associated with serous macular detachment. Fundus examination of both eyes showed foveal serous retinal detachment, which was confirmed by optical coherence tomography. Topical nepafenac 0.1% eye drops were started as single drop every 8 hours for 4 weeks. One month later, the serous macular detachment had regressed and BCVA increased to 20/20 in both eyes. To the best of our knowledge, this is the first reported case of bilateral serous macular detachment presumably caused by pregabalin intoxication.

Pregabalin poisoning: Evaluation of dose‐toxicity relationship

“…From the case series, seven individual patients were described in detail (dose and clinical course). Individual patients are presented in Table 2 (dose‐ranked) 6–10,14–17 . Case series are presented in Table 3, including data on study population, number of patients included, pregabalin dose, clinical course and hospitalization 6,7,15,18–22 …”

“…dose-ranked) [6][7][8][9][10][14][15][16][17]. Case series are presented in Table3, including data on study population, number of patients included, pregabalin dose, clinical course and hospitalization[6,7,15,[18][19][20][21][22].…”

Pregabalin as a probable cause of central serous chorioretinopathy: Two case reports

“…[ 8 , 10 , 14 ] Interestingly, case reports in the literature suggest that pregabalin overdose may lead to macular bilateral vision loss due to bilateral serous macular detachment. [ 11 ] Topiramate, another antiepileptic agent, can also cause neurosensory retinal detachment. [ 12 ] Furthermore, pregabalin add-on therapy may result in downbeat nystagmus.13 These case reports are in parallel indicating a probable causal link between antiepileptic medications and occurrence of ocular disorders such as CSCR.…”

“…[ 10 ] The most common ocular side effects of pregabalin are blurred vision, abnormal vision, conjunctivitis, and diplopia, while, less frequently, ocular pain, ocular swelling, photosensitivity reaction, dry eye, blepharitis, strabismus, keratitis, uveitis, photopsia, and irritation are reported. [ 7 , 11 ] Pregabalin overdose may lead to bilateral vision loss due to bilateral serous macular detachment as reported by a single suicide attempt. [ 11 ] Another case report suggests that topiramate, an antiepileptic agent, may be linked to acquired myopia followed by neurosensory retinal detachment at the posterior pole in left eye.…”

“…[ 7 , 11 ] Pregabalin overdose may lead to bilateral vision loss due to bilateral serous macular detachment as reported by a single suicide attempt. [ 11 ] Another case report suggests that topiramate, an antiepileptic agent, may be linked to acquired myopia followed by neurosensory retinal detachment at the posterior pole in left eye. [ 12 ] Pregabalin add-on therapy has been also reported as a probable cause for the occurrence of downbeat nystagmus.…”