Bilateral Serous Macular Detachment After Attempted Suicide with Pregabalin

Abstract

A 24-year-old female presented with bilateral vision loss following attempted suicide with pregabalin. Her best-corrected visual acuity (BCVA) was 20/40 in the right eye and 20/50 in the left eye. The bilateral visual disturbance was associated with serous macular detachment. Fundus examination of both eyes showed foveal serous retinal detachment, which was confirmed by optical coherence tomography. Topical nepafenac 0.1% eye drops were started as single drop every 8 hours for 4 weeks. One month later, the serous macular detachment had regressed and BCVA increased to 20/20 in both eyes. To the best of our knowledge, this is the first reported case of bilateral serous macular detachment presumably caused by pregabalin intoxication.

Keywords: pregabalin; serous macular detachment; suicide; Optical coherence tomography.

Figure 1. Color fundus photography and fundus fluorescein angiography of a 24-year-old female patient at her initial presentation to our clinic; (a, b) color fundus image shows absent foveal reflex in both eyes due to subretinal fluid; (c, d) fundus fluorescein angiography shows bilateral spots of hypofluorescence starting in early phases and continuing in late phases (e, f) in the posterior pole.

Figure 2. Optical coherence tomography images obtained in another center and in our center after discharge from intensive care; (a, b) optical coherence tomography taken in the other center 3 days after the suicide attempt shows bilateral serous detachment that is more pronounced in the right eye; (c, d) optical coherence tomography taken in our clinic 1 week later shows significant reduction of the subretinal fluid in both eyes compared to the initial images; (e, f) in optical coherence tomography taken 1 month later the subretinal fluid had totally regressed