A Case of Phentermine Hydrochloride Induced Acute Myopia and Acute Angle Closure

Sung Hyun Koo; Won Suk Choi; Jong Wook Lee; Young Jeung Park; Kyoo Won Lee

doi:10.3341/jkos.2011.52.7.881

Journal List > J Korean Ophthalmol Soc > v.52(7) > 1009091

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Koo, Choi, Lee, Park, and Lee: A Case of Phentermine Hydrochloride Induced Acute Myopia and Acute Angle Closure

Original Article

J Korean Ophthalmol Soc 2011;52(7):881-886.

Published online: 7 September 2011

DOI: https://doi.org/10.3341/jkos.2011.52.7.881

A Case of Phentermine Hydrochloride Induced Acute Myopia and Acute Angle Closure

Sung Hyun Koo, MD, Won Suk Choi, MD, Jong Wook Lee, MD, Young Jeung Park, MD, PhD, Kyoo Won Lee, MD, PhD

Cheil Eye Hospital, Daegu, Korea

Address reprint requests to Kyoo Won Lee, MD, PhD Cheil Eye Hospital #803-2 Sinam-dong, Dong-gu, Daegu 701-011, Korea Tel: 82-53-959-1751, Fax: 82-53-959-1758, E-mail: eye7575@korea.com

Received 9 September 2010 Revised 5 November 2010 Accepted 13 April 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To describe a case of bilateral acute myopia and acute angle-closure associated with phentermine hydrochloride, a drug used for obesity treatment.

Case summary

A 25-year-old woman visited our hospital with blurry vision and ocular pain after taking phentermine hydrochloride for three weeks. Manifest refraction accompanied myopic shift in the both eyes, slit-lamp examination showed forward displacement of the lens-iris diaphragm and fundus examination revealed retinal folds. Suspecting phentermine hydrochloride induced acute myopia and acute angle closure, discontinuation of the drug and administration of cycloplegic agents and antiglaucomatic agent successfully resolved the symptoms.

Conclusions

Although the exact mechanism is unknown, phentermine hydrochloride may generate ciliochoroidal effusion and ciliary edema, lead to acute myopia and acute angle closure resulting from forward displacement of the lens-iris diaphragm.

Keywords: Acute angle closure, Acute myopia, Phentermine hydrochloride

References

1. Bovino JA, Marcus DF. The mechanism of transient myopia induced by sulfonamide therapy. Am J Ophthalmol. 1982; 94:99–102.

2. Krieg PH, Schipper I. Drug-induced ciliary body oedema: a new theory. Eye. 1996; 10:121–6.

3. Mandelkorn RM. Drug induced glaucoma. Zimmerman TJ, Kooner KS, editors. Clinical Pathway in Glaucoma. 1st ed.New York: Thieme Medical Publishers Inc.;2001. 1:chap 15.

4. Grant WM. Ocular complications of drugs. Glaucoma. JAMA. 1969; 207:2089–91.

5. Stamper RL, Lieberman MF, Drake MV. Becker-Shaffer's Diagnosis and Therapy of the Glaucoma. 8th ed.St. Louis: The CV Mosby Company;2009. p. 196.

6. Mandelkorn RM, Zimmerman TJ. Effects of nonsteroidal drugs on glaucoma. Ritch R, Shields MB, editors. The Secondary Glaucomas. 1st ed.St Louis: CV Mosby;1:chap 16.

7. Mitchell JD, Schwartz AL. Acute angle-closure glaucoma associated with intranasal cocaine abuse. Am J Ophthalmol. 1996; 122:425–6.

8. Kim SW, Seo SG, Her J, et al. Two cases of topiramate-induced acute myopia. J Korean Ophthalmol Soc. 2008; 49:1033–40.

9. Jeon C, Kee CW. Topiramate-induced acute angle-closure glaucoma. J Korean Ophthalmol Soc. 2005; 46:1944–50.

10. Kim KK, Cho HJ, Kang HC, et al. Effects on weight reduction and safety of short-term phentermine administration in Korean obese people. Yonsei Med J. 2006; 47:614–25.

11. Rothman RB, Hendricks EJ. Phentermine cardiovascular safety. Am J Emerg Med. 2009; 27:1010–3.

12. Rothman RB. Does phentermine inhibit monoamine oxidase? Lancet. 1999; 353:1362–3.

13. Rothman RB, Baumann MH, Dersch CM, et al. Amphetamine-type central nervous system stimulants release norepinephrine more potently than they release dopamine and serotonin. Synapse. 2001; 39:32–41.

14. Balcioglu A, Wurtman RJ. Effects of phentermine on striatal dopamine and serotonin release in conscious rats: in vivo micro-dialysis study. Int J Obes Relat Metab Disord. 1998; 22:325–8.

15. Alexander M, Rothman RB, Baumann MH, et al. Noradrenergic and dopaminergic effects of amphetamine-like stimulants in the baboon Papio anubis. Synapse. 2005; 56:94–9.

16. Tao R, Fray A, Aspley S, et al. Effects on serotonin in rat hypothal-amus of D-fenfluramine, aminorex, phentermine and fluoxetine. Eur J Pharmacol. 2002; 445:69–81.

17. Adipex-P®. Physicians' Desk Reference: PDR. 58th ed.Montvale, NJ: Medical Economics Co. Inc;2004. p. 1341–2.

18. Berns W. Proceedings of the Meeting of the Swedish Ophthalmological Society, 3rd December, 1938. Acta Ophthalmol. 1940; 18:96–8.

19. Ryan EH Jr, Jampol LM. Drug-induced acute transient myopia with retinal folds. Retina. 1986; 6:220–3.

20. Craig JE, Ong TJ, Louis DL, Wells JM. Mechanism of top-iramate-induced acute-onset myopia and angle closure glaucoma. Am J Ophthalmol. 2004; 137:193–5.

21. Banta JT, Hoffman K, Budenz DL, et al. Presumed top-iramate-induced bilateral acute angle-closure glaucoma. Am J Ophthalmol. 2001; 132:112–4.

22. Medeiros FA, Zhang XY, Bernd AS, Weinreb RN. Angle-closure glaucoma associated with ciliary body detachment in patients using topiramate. Arch Ophthalmol. 2003; 121:282–5.

23. Fraunfelder FW, Fraunfelder FT, Keates EU. Topiramate-associated acute, bilateral, secondary angle-closure glaucoma. Ophthalmology. 2004; 111:109–11.

24. Abramson DH, Coleman DJ, Forbes M, Franzen LA. Pilocarpine. Effect on the anterior chamber and lens thickness. Arch Ophthalmol. 1972; 87:615–20.

25. Mapstone R. Acute shallowing of the anterior chamber. Br J Ophthalmol. 1981; 65:446–51.

26. Kwon GR, Kee CW. A case of bilateral malignant glaucoma with ciliochoroidal detachment. J Korean Ophthalmol Soc. 1998; 39:614–8.

27. Rhee DJ, Ramos-Esteban JC, Nipper KS. Rapid resolution of top-iramate-induced angle-closure glaucoma with methylprednisolone and mannitol. Am J Ophthalmol. 2006; 141:1133–4.

Figure 1.

ORB scan of both eyes after use of phentermine hydrochloride for 3 weeks shows shallow anterior chamber (Yellow arrow: anterior chamber depth).

Figure 2.

Fundus photographs after use of phentermine hydrochloride for 3 weeks showed retinal folds at perimacular area (A, B). After using cycloplegics and ceasing phentermine hydrochloride for 1 week, retinal folds disappeared (C, D) (White arrow: retinal folds).

Table 1.

The change before and after using the phentermine hydrochloride

		UCVA^*(log MAR)	BSCVA^†(log MAR)	Spherical equivalent (D)	Intraocular pressure (mm Hg)	Anterior chamber depth (mm)
Before use of phentermine	OD	1	0	−5.00	15	3.17
hydrochloride	OS	1	0	−4.88	17	3.20
After use of phentermine hydrochloride	OD	2	0.15	−10.25	28	2.05
for 3 weeks	OS	1.4	0.15	−10.63	29	1.88
After use of cycloplegics and ceasing	OD	1	0	−5.50	13	3.15
phentermine hydrochloride for 1 week	OS	1	0	−5.25	16	3.16

^* UCVA = uncorrected visual acuity

^† BSCVA = best spectacle corrected visual acuity.

TOOLS

Similar articles