J Korean Ophthalmol Soc.  2016 Jun;57(6):1026-1030. 10.3341/jkos.2016.57.6.1026.

A Case of Pigmentary Glaucoma Due to Multidrug-Resistant Tuberculosis Treatment

• Jung JW
• Jo SH
• Seo JH
• Kim YS

• KMID: 2290511
• DOI: http://doi.org/10.3341/jkos.2016.57.6.1026

Abstract

PURPOSE
To report a case of secondary pigmentary glaucoma due to clofazimine treatment for extensive drug-resistant tuberculosis.
CASE SUMMARY
A 23-year-old man presented with blurred vision in both eyes. The patient started to take clofazimine for extensive drug-resistant tuberculosis six months prior, after which his facial skin color changed to a dark-brown. Intraocular pressure (IOP) was 50 mm Hg in the right eye and 48 mm Hg in the left eye. Slit lamp examination revealed corneal edema, opacity, and flare in the anterior chamber in both eyes. A color vision test revealed a mild color defect in both eyes. Visual field (VF) test revealed superior temporal VF loss in the left eye. Gonioscopy revealed open angles with high pigmentation in the trabecular meshwork in both eyes. The patient was diagnosed with pigmentary glaucoma, and maximum tolerated medical therapy was performed. However, the IOP was uncontrolled. Trabeculectomy was performed in both eyes. Postoperative IOP was measured to be 12 mm Hg in both eyes without medication, and visual acuity measured 20/22 in the right eye and 20/17 in the left eye.
CONCLUSIONS
To the best of our knowledge, this report is the first case of clofazimine being a possible cause of pigmentary glaucoma in a patient with extensive drug-resistant tuberculosis.

Keyword

Clofazimine; Extensive drug-resistant tuberculosis; Pigmentary glaucoma; Trabeculectomy

MeSH Terms

Anterior Chamber
Clofazimine
Color Vision
Corneal Edema
Glaucoma, Open-Angle*
Gonioscopy
Humans
Intraocular Pressure
Pigmentation
Skin Pigmentation
Slit Lamp
Trabecular Meshwork
Trabeculectomy
Tuberculosis, Multidrug-Resistant*
Visual Acuity
Visual Fields
Young Adult
Clofazimine

Figure

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  Figure 1. Ultrasound biomicroscopy examination. There are no changes of location of ciliary body and edema in both eyes (A, B). OD = oculus dexter; OS = oculus sinister.

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  Figure 2. Gonioscopy examination. Before trabeculectomy gonioscopy examination shows pigment deposited on the trabecular meshwork (A, B; arrows), After trabeculectomy and stop medication clofazimine (CFZ), pigment deposits resolved (C, D; arrows). OD = oculus dexter; OS = oculus sinister.

• 

  Figure 3. Photographs of patient's skin color. Before patient start tuberculosis medication, Patient's skin was not so dark color (A). After 6 month from medication of clofazimine (CFZ), skin color changed to dark-brown (B). After Trabeculectomy and stopping medication (CFZ), skin color shows improvement (C).

• 

  Figure 4. Anterior photograph. At 5 months postoperative, pigment deposits showed on bleb in left eye (A, B; arrows). OS = oculus sinister.

Reference

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