J Korean Ophthalmol Soc.  2020 Mar;61(3):313-318. 10.3341/jkos.2020.61.3.313.

Bilateral Acute Angle Closure Attack and Choroidal Detachment in Patient with Acquired Immune Deficiency Syndrome

Affiliations
  • 1Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea. jlee@pusan.ac.kr
  • 2Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.

Abstract

PURPOSE
To report a case of simultaneous bilateral acute angle closure attack combined with bilateral choroidal detachment in a patient with acquired immune deficiency syndrome (AIDS).
CASE SUMMARY
A 63-year-old male who had a history of several months of diarrhea, abdominal pain, and weight loss visited the emergency room with sudden bilateral blurred vision accompanied with headache, periocular pain, nausea, and vomiting. His visual acuity was finger counting in both eyes and the intraocular pressure (IOP) was 49/44 mmHg (right/left). The anterior chamber depth was three times the corneal thickness in the center and less than 1/4 of the corneal thickness in the periphery in both eyes. Maximum medical therapy had no effect and emergency cataract surgery combined with vitrectomy was performed on the right eye. During surgery, severe choroidal detachment was noted. One day after surgery, choroidal detachment was also found in the left eye and emergency cataract surgery with suprachoroidal fluid drainage was performed. Approximately 1 month after surgery, choroidal detachment of both eyes regressed without systemic therapy. The IOP was 14/7 mmHg (right/left) with a visual acuity of 0.32/0.4 (right/left). The blood test performed in the emergency room showed a positive result for AIDS and the patient started medical therapy.
CONCLUSIONS
In patients with AIDS, bilateral simultaneous acute angle closure attack combined with choroidal detachment may rarely develop. Although choroidal effusion can regress spontaneously, combined suprachoroidal fluid drainage is recommended when a surgical intervention is required.

Keyword

Bilateral acute angle closure; Choroidal detachment; Human immunodeficiency virus

MeSH Terms

Abdominal Pain
Acquired Immunodeficiency Syndrome*
Anterior Chamber
Cataract
Choroid*
Diarrhea
Drainage
Emergencies
Emergency Service, Hospital
Fingers
Headache
Hematologic Tests
HIV
Humans
Intraocular Pressure
Male
Middle Aged
Nausea
Visual Acuity
Vitrectomy
Vomiting
Weight Loss

Figure

  • Figure 1. Color fundus photo (upper) and optical coherence tomography (lower) of both eye at the day of angle closure attack. The images demonstrate no remarkable macular lesion in both eyes (A, B). Fundus photos are blurry visible because of the corneal edema. OD = oculus dexter; OS = oculus sinister; N = nasal; T = temporal.

  • Figure 2. Wide fundus photographs of the both eyes. After right eye cataract surgery combined with total vitrectomy, 360˚ choroidal detachment was found in both eyes (A). Spontaneous regression of the detachment was noted gradually without therapy as shown in the fundus photographs (B-D). Choroidal detachment was almost completely regressed after 1.5 months (E). OD = oculus dexter; OS = oculus sinister; POD = post-oper-ative day.

  • Figure 3. Ultrasound B-scan of both eyes (1 day after right eye surgery and left eye is preoperative state). B-scan images demonstrate ciliochoroidal effusion and detachment in both eyes. OD = oculus dexter; OS = oculus sinister.


Reference

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