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

Keun Heung Park; Jae Jung Lee; Ji Woong Lee; Ji Eun Lee

doi:10.3341/jkos.2020.61.3.313

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Park, Lee, Lee, and Lee: Bilateral Acute Angle Closure Attack and Choroidal Detachment in Patient with Acquired Immune Deficiency Syndrome

Case Report

J Korean Ophthalmol Soc 2020;61(3):313-318.

Published online: 25 September 2020

DOI: https://doi.org/10.3341/jkos.2020.61.3.313

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

Keun Heung Park, MD^1,², Jae Jung Lee, MD^1,², Ji Woong Lee, MD, PhD^1,², Ji Eun Lee, MD, PhD^1,²

¹Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea

²Biomedical Research Institute, Pusan National University Hospital, Busan, Korea

Address reprint requests to Ji Eun Lee, MD, PhD Department of Ophthalmology, Pusan National University Hospital, #179 Gudeok-ro, Seo-gu, Busan 49241, Korea Tel: 82-51-240-7957, Fax: 82-51-242-7341 E-mail: jlee@pusan.ac.kr

Received 21 March 2019 Revised 22 July 2019 Accepted 21 February 2020

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 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.

Keywords: Bilateral acute angle closure, Choroidal detachment, Human immunodeficiency virus

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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.

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