Presumed Furosemide-associated Bilateral Angle-Closure Glaucoma

Purpose: To report a case of presumed furosemide-associated bilateral angle-closure glaucoma. Methods: Retrospective case report with spectral domain anterior segment optical coherence tomography imaging. Results: A 21-year-old African American woman in her 17th week of pregnancy presented with acute angle-closure glaucoma in both eyes after being started on furosemide in her first trimester for fluid overload. Intraocular pressures were elevated in the low 40s mm Hg bilateral (OU) and anterior chambers were shallow with narrow grade 1 angles on gonioscopy (Schaffer classification). Medical history included type 1 diabetes mellitus, chronic kidney disease, and 2 prior failed pregnancies complicated by fluid overload. She was started on 60 mg of prednisone daily along with topical brimonidine in both eyes twice daily. After 3 days, her intraocular pressures normalized. At 1 week, slit-lamp examination showed deepened anterior chambers and gonioscopy confirmed widened angles. Oral prednisone was titrated down slowly for the remainder of her uneventful pregnancy. On follow-up 1 month after delivery, intraocular pressures and best-corrected visual acuities reached preterm baseline values of 15mm Hg OU and 20/30 OU. Conclusions: This is the first reported case of furosemide-associated bilateral angle-closure glaucoma. Similar idiosyncratic reactions following exposure to other sulphonamide-containing drugs have been described. We propose discontinuation of the offending agent and treatment with oral prednisone in similar clinical settings.