Malignant glaucoma due to drug-related angioedema.
OBJECTIVE
To report postsurgery angioedema resulting in malignant glaucoma. Interventional case report.


METHODS
Three hours after uncomplicated cataract surgery on the right eye, a 61-year-old woman developed angioedema with swelling of the parapharyngeal tissue. Visual acuity deteriorated, and tonometry revealed an intraocular pressure of 60 mm Hg, with shallow anterior chambers, in both eyes.


RESULTS
Ultrasound showed choroidal effusion on both eyes. Intraocular pressure could only be controlled surgically by procedure to deepen the anterior chamber. The angioedema regressed after withdrawal of candesartan, an angiotensin II antagonist that the patient had taken for 1 year.


CONCLUSIONS
Angioedema without urticaria is well documented in patients receiving angiotensine-converting enzyme inhibitors or angiotensin II antagonists. Drug-related angioedema may lead to a choroidal effusion syndrome with malignant glaucoma. Surgical intervention may trigger angioedema. Most important in treatment is withdrawal from the implicated medication and control of intraocular pressure.
Hille
Konrad
K
Department of Ophthalmology and Eye Hospital, University of Saarland, Homburg/Saar, Germany. aukhil@uniklinik-saarland.de
Hille
Annette
A
Ruprecht
Klaus W
KW
D000799:Angioedema / Q000139:chemically induced* / Q000000981:diagnostic imaging; D057911:Angiotensin Receptor Antagonists; D000959:Antihypertensive Agents / Q000009:adverse effects*; D001562:Benzimidazoles / Q000009:adverse effects*; D001713:Biphenyl Compounds; D015862:Choroid Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D005260:Female; D005901:Glaucoma / Q000209:etiology*; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects; D008875:Middle Aged; D018918:Phacoemulsification; D010608:Pharyngeal Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging; D013777:Tetrazoles / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D014792:Visual Acuity
D057911:Angiotensin Receptor Antagonists; D000959:Antihypertensive Agents; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D013777:Tetrazoles; C081643:candesartan