Can diuretics increase the risk of acute angle closure glaucoma?
Reviewed by Nishita Patel

Diuretics, used widely in the treatment of hypertension, oedema, heart failure and liver failure, have been implicated in case reports in scientific literature to be linked to bilateral acute angle closure glaucoma (AACG). The aim of this study was to determine whether AACG is linked to the use of diuretics. A nested case-control study was conducted using the PharMetrics Plus database. A cohort of new users of diuretics was constructed which included patients who were prescribed thiazides only, loop diuretics only, potassium-sparing only, combinations of diuretics and a negative control drug amlodipine, between 2006 and 2020. Patients who had used a competing diuretic prior to cohort entry were excluded. For each case of AACG that had been coded by an ophthalmologist, four controls were selected and matched by age and sex using density-based sampling. A conditional logistic regression model was used to compute rate ratios (RRs) adjusted for the following covariates: topiramate, bupropion, sulphonamide antibiotics, acetazolamide, and sulfasalazine. The RRs for a negative control drug, amlodipine, were also assessed. Of the 713,574 diuretics users, 1553 cases and 6212 controls were identified. No increase in the risk of AACG with current users of diuretics was found; RR=1.06 for all diuretics (95% CI: 0.81–1.37); RR=0.97 for thiazides (95% CI: 0.71–1.32); RR=1.24 for loop diuretics (95% CI: 0.90–1.73); RR=0.99 for potassium sparing (95% CI: 0.73–1.36). The main limitation was the inability to access the patient records due to the nature of the PharMetrics Plus database to confirm AACG diagnosis and verify whether the case was unilateral or bilateral, given the latter would be more fitting with a drug-related adverse reaction. Access to patient records would also make it possible to determine the indication for acetazolamide, which can cause AACG, as well as be used for its treatment, and confirm whether patients were compliant with the prescribed diuretics. This is the first epidemiological study to investigate the potential link between use of diuretics and AACG and was able to control major confounders through matching. Future studies would be required to validate these findings.

Use of diuretics and risk of acute angle closure: a case-control study.
Qiao GL, Mikelberg FS, Etminan M.
OPHTHALMIC EPIDEMIOLOGY
2024;31:321–4.