Amantadine and Corneal Deposits

Abstract

blurred vision in the left eye. Visual acuity was 20/100; the intraocular pressure was 38 mm Hg with mild conjunctival injection and a clear cornea. The anterior chamber was shallow; the pupil was 2 mm in diameter and not responsive to light. A patent iridotomy, incipient cataract, and normal fundus with cup/disk ratio of 0.6 were observed. Gonioscopy disclosed a completely closed angle. The patient was treated initially with hyperosmotic agents and topical pilocarpine 4%. After three days of unsuccessful medical treatment trabeculectomy was performed. Postoperatively the intraocular pressure rose to 45 mm Hg with a flat anterior chamber. Malignant glaucoma was diagnosed and intensive treatment with cycloplegics and mannitol was given. The anterior chamber did not reform and air was injected into the anterior chamber. This was followed two days later by pars plana vitrectomy with Healon injection to the anterior chamber. Despite transient improvement the pressure again rose with recurrent shallowing of the anterior chamber. Deep vitrectomy to aspirate the aqueous from the vitreous resulted in maintenance of normal intraocular pressure and a moderately deep anterior chamber. Two weeks later the intraocular pressure rose suddenly to 50 mm Hg, and a shallow anterior chamber was noted. Pars plana vitrectomy and lensectomy were successfully performed. Five months postoperatively the best-corrected visual acuity was 20/40. Slit-lamp examination of the left eye showed a clear cornea, deep anterior chamber, and intraocular pressure of 15 mm Hg without medical treatment. On reassessing the development of our patient's illness we think it is possible that the course of malignant glaucoma began after the prophylactic laser iridotomy that she had undergone three months previously. This could explain the lack of response to conventional treatment (pilocarpine and acetazolamide) that she received on admission. The administration of a cycloplegic at this stage might have prevented the progression of the malignant glaucoma and the ensuing surgical intervention.