Malignant glaucoma due to drug-related angioedema

PURPOSE: To report postsurgery angioedema resulting in malignant glaucoma.Interventional case report. METHODS: Three hours after uncomplicated cataract surgery on the right eye, a 61-year-old woman developed angioedema with swelling of the parapharyngeal tissue. Visual acuity deteriorated, and tonometry revealed an intraocular pressure of 60 mm Hg, with shallow anterior chambers, in both eyes. RESULTS: Ultrasound showed choroidal effusion on both eyes. Intraocular pressure could only be controlled surgically by procedure to deepen the anterior chamber. The angioedema regressed after withdrawal of candesartan, an angiotensin II antagonist that the patient had taken for 1 year. CONCLUSIONS: Angioedema without urticaria is well documented in patients receiving angiotensine-converting enzyme inhibitors or angiotensin II antagonists. Drug-related angioedema may lead to a choroidal effusion syndrome with malignant glaucoma. Surgical intervention may trigger angioedema. Most important in treatment is withdrawal from the implicated medication and control of intraocular pressure.