Reactions Weekly | 2021
Celecoxib/parecoxib
Abstract
Myopic shift: case report A 30-year-old woman developed myopic shift during treatment with parecoxib and celecoxib for postoperative pain relief [routes and dosages not stated]. The woman post-laparotomy and myomectomy was evaluated by ophthalmology for bilateral blurry vision that had begun two days after the operation. She had received intraoperative medications, which included propofol, glycopyrrolate, dexamethasone, cefazolin [cephazolin], sevoflurane, fentanyl, midazolam, vecuronium-bromide [vecuronium], oxycodone, ondansetron, parecoxib, metaraminol, paracetamol and neostigmine. Her medical history includes uterine fibroids, which necessitated a previous myomectomy, and hypothyroidism caused by Hashimoto’s thyroiditis, for which she was receiving levothyroxine-sodium [thyroxine]. Although she received similar medications other than COX-2 inhibitors during the last myomectomy, she did not experience any postoperative visual impairment. She developed mild myopia (-0.25). Post-operatively, she received oxycodone, cefazolin, celecoxib, and paracetamol and ondansetron accessible PRN. She was myopic (-5 and -4.5 dioptres in both eyes), with best corrected visual acuity of 6/5 in both eyes during the initial examination. Her anterior chamber was shallow (left eye 2.76mm and right eye 2.77mm) with axial lengths (left eye 22.68mm and right eye 22.79mm), respectively. Her autorefraction was -4.75+ 0.50 (left eye) and -6.00 +1.50 (right eye). B-ultrasound showed that the size and position of the ciliary body were normal, and there was no uveal effusion. Photographs of her anterior segment OCT revealed an anterior chamber that was open but shallow. The woman received cyclopentolate treatment, and 30 minutes later, her pupils dilated, and her refraction and angle improved slightly (right eye diopter is -3 diopter, left eye diopter is -2.5 diopter). The IOL master initially showed a shallow anterior segment and a thick lens, most likely due to the anterior movement of the iris diaphragm of the lens. Repeated evaluations after dilation showed that the lens iris diaphragm moved back to its normal anatomical position, which resulted in increased zonular tension and subtle lens thinning. After 3 days, her myopia persisted, leading to the discontinuation of celecoxib and cyclopentolate. A diagnosis of COX-2 inhibitors-induced myopic shift was made due to long-term anterior displacement of the lens iris diaphragm with lens thickness. Two days later, after celecoxib was discontinued, her vision and myopia were significantly improved and her vision quickly returned to normal.