Angiographic features of drug-induced bilateral angle closure and transient myopia with Ciliochoroidal effusion

Abstract Background To report five cases of acute drug-induced angle closure and transient myopia with ciliochoroidal effusion and to analyze angiographic findings of these cases. Methods This study is an observational case series. Five patients with acute drug-induced angle closure and transient myopia with ciliochoroidal effusion were examined by fluorescein angiography, indocyanine green angiography (ICGA) and ultrasound biomicroscopy (UBM). Results Five patients presented with bilateral visual loss and ocular pain after intake of topiramate, methazolamide, phendimetrazine tartrate or mefenamic acid. All patients showed elevated intraocular pressure (IOP) with shallow anterior chamber and myopic shift from − 0.5 to − 17.0 diopters (D). UBM showed ciliochoroidal effusions with diffuse thickening of the ciliary body in all cases. Rapid normalization of IOP and decrease of myopic shift occurred in all patients after discontinuing the suspected drugs. We classified the ICGA findings into 2 major signs (hypofluorescent dark spots, hyperfluorescent pinpoints) and 3 minor signs (diffuse choroidal hyperfluorescence, early hyperfluorescence of choroidal stromal vessel, and leakage and dilated retinal vessels). Conclusions The pathogenesis of acute drug-induced angle closure and transient myopia with ciliochoroidal effusion may be idiosyncratic reaction of uveal tissue to systemic drugs. Accumulation of extravascular fluid in the ciliochoroidal layer had a major role in the pathogenesis. ICGA could be a useful method to examine the pathophysiology of this condition by imaging of the choroidal layer.

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Angiographic Features of Drug-Induced Bilateral Angle Closure and Transient Myopia with Ciliochoroidal Effusion

10.21203/rs.2.323/v2 ◽

2019 ◽

Author(s):

Yong Koo Kang ◽

Byeong Jae Son ◽

Dong Ho Park ◽

Jae Pil Shin

Keyword(s):

Case Series ◽

Basic Mechanism ◽

Ultrasound Biomicroscopy ◽

Angle Closure ◽

Drug Induced ◽

Idiosyncratic Reaction ◽

Transient Myopia ◽

Extravascular Fluid ◽

Ciliochoroidal Effusion ◽

Shallow Anterior Chamber

Abstract Background: To report five cases of acute drug-induced bilateral angle closure and transient myopia with ciliochoroidal effusion, and to suggest a pathogenesis for this condition based upon angiography. Methods: This study is an observational case series. Five patients with acute drug-induced angle closure with ciliochoroidal effusion were examined by ultrasound biomicroscopy, fluorescein angiography, and indocyanine green angiography (ICGA). Results: Five patients presented with bilateral visual impairment and ocular pain after treatment with mefenamic acid, phendimetrazine tartrate, topiramate, or methazolamide. All patients presented a shallow anterior chamber and elevated intraocular pressure in both eyes. They showed a myopic shift from -0.5 to -17.0 diopters. Ultrasound biomicroscopy revealed annular ciliochoroidal effusions with diffuse thickening of the ciliary body in all cases. Rapid clinical improvement occurred in all patients after discontinuing the suspected drugs. ICGA findings were classified into two major signs (hypofluorescent dark spots and hyperfluorescent pinpoints) and three minor signs (early choroidal stromal vessel hyperfluorescence and leakage, diffuse hyperfluorescence of the choroid, and tortuous and dilated retinal vessels). Conclusions: The basic mechanism of pathogenesis involved an idiosyncratic reaction in uveal tissue to systemic drugs. Angiography showed that accumulation of extravascular fluid in the ciliochoroidal layer had a major role in pathogenesis. Angiography could therefore be a useful method to examine the pathophysiology of this condition by imaging of the choroidal layer.

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Angiographic Features of Drug-Induced Bilateral Angle Closure and Transient Myopia with Ciliochoroidal Effusion

10.21203/rs.2.323/v1 ◽

2019 ◽

Author(s):

Yong Koo Kang ◽

Byeong Jae Son ◽

Dong Ho Park ◽

Jae Pil Shin

Keyword(s):

Indocyanine Green ◽

Indocyanine Green Angiography ◽

Case Series ◽

Ultrasound Biomicroscopy ◽

Angle Closure ◽

Drug Induced ◽

Idiosyncratic Reaction ◽

Transient Myopia ◽

Ciliochoroidal Effusion ◽

Myopic Shift

Abstract Background: To report five cases of acute drug-induced angle closure and transient myopia with ciliochoroidal effusion and to analyze angiographic findings of these cases. Methods: This study is an observational case series. Five patients with acute drug-induced angle closure and transient myopia with ciliochoroidal effusion were examined by fluorescein angiography, indocyanine green angiography (ICGA) and ultrasound biomicroscopy (UBM). Results: Five patients presented with bilateral visual loss and ocular pain after intake of topiramate, methazolamide, phendimetrazine tartrate or mefenamic acid. All patients showed elevated intraocular pressure (IOP) with shallow anterior chamber and myopic shift from -0.5 to -17.0 diopters (D). UBM showed ciliochoroidal effusions with diffuse thickening of the ciliary body in all cases. Rapid normalization of IOP and decrease of myopic shift occurred in all patients after discontinuing the suspected drugs. We classified the ICGA findings into 2 major signs (hypofluorescent dark spots, hyperfluorescent pinpoints) and 3 minor signs (diffuse choroidal hyperfluorescence, early hyperfluorescence of choroidal stromal vessel, and leakage and dilated retinal vessels). Conclusions: The pathogenesis of acute drug-induced angle closure and transient myopia with ciliochoroidal effusion may be idiosyncratic reaction of uveal tissue to systemic drugs. Accumulation of extravascular fluid in the ciliochoroidal layer had a major role in the pathogenesis. ICGA could be a useful method to examine the pathophysiology of this condition by imaging of the choroidal layer. Keywords: Ciliochoroidal effusion; Drug-induced angle closure; Indocyanine green angiography; Transient myopia.

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Angle-closure glaucoma, iris-lens contact, ciliochoroidal effusion, and transient myopia induced by topiramate

Fyodorov journal of ophthalmic surgery ◽

10.25276/0235-4160-2021-1-57-62 ◽

2021 ◽

pp. 57-62

Author(s):

T.V. Sokolovskaya ◽

◽

V.N. Yashina ◽

N.A. Mahno ◽

◽

...

Keyword(s):

Visual Acuity ◽

Nd:Yag Laser ◽

Scientific Literature ◽

Angle Closure Glaucoma ◽

Angle Closure ◽

Migraine Treatment ◽

Transient Myopia ◽

Ciliochoroidal Effusion ◽

Peripheral Iridectomy ◽

Myopic Shift

Topiramate is a sulphonamide derivative indicated in the treatment of epilepsy and migraine. In foreign scientific literature there are reported cases of topiramate-induced bilateral angle-closure glaucoma and acute myopia with ciliochoroidal effusion. Purpose. To evaluate outcomes of laser iridectomy in a patient with topiramate-induced angle-closure glaucoma and acute myopia with ciliochoroidal effusion. Material and methods. A case is reported of bilateral angle-closure glaucoma, iris-lens contact, ciliochoroidal detachment and acute myopia following topiramate for migraine treatment in a 32-year-old patient. Laser peripheral iridectomy was performed in the both eyes according to the standard technology (Nd:YAG laser Selecta Trio, Lumenis Ltd., Israel) to decrease IOP and restore visual functions. Results. After laser iridectomy, the examination showed normal IOP with no medication, ciliochoroidal effusion and induced myopic shift were relieved. Conclusion. Laser iridectomy is an effective and safe in the treatment of topiramate-induced angle-closure glaucoma, acute myopia, and ciliochoroidal detachment. It contributes to normalization of IOP and improvement of visual acuity. Key words: topiramate, angle-closure glaucoma, ciliochoroidal effusion, transient myopia.

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Acute Angle-Closure Crisis Secondary to Topiramate-Induced Ciliochoroidal Effusion With Underlying Plateau Iris Configuration

Journal of Diagnostic Medical Sonography ◽

10.1177/87564793211035777 ◽

2021 ◽

pp. 875647932110357

Author(s):

Steven R. Shen ◽

Erin A. Boese ◽

Courtney P. Clark ◽

Xiaofei Man ◽

Melisa Nika ◽

...

Keyword(s):

Side Effect ◽

Ciliary Body ◽

Case Series ◽

Ultrasound Biomicroscopy ◽

Acute Angle ◽

Migraine Prophylaxis ◽

Angle Closure ◽

Anatomical Feature ◽

Ciliochoroidal Effusion ◽

Acute Angle Closure

Objective: The development of ciliochoroidal effusions and secondary acute angle-closure crisis (AACC) is an uncommon side effect of topiramate, a common antiepileptic now FDA-approved for migraine prophylaxis. The mechanisms that underlie the development of ciliochoroidal effusions after topiramate use remain unclear. Materials and Methods: Ultrasound biomicroscopy (UBM) was also performed in all participants after stopping topiramate. Results: Six patient cases are presented with medication-induced AACC following the initiation or escalation of topiramate. Ciliochoroidal effusions were confirmed by gray-scale sonography in all patients at presentation. The images revealed either plateau iris configuration or atypical plateau iris configuration. Plateau iris configuration is defined by presence of an anteriorly rotated ciliary body processes and an absent posterior sulcus. Atypical plateau iris configuration refers to when the iris inserts directly into the ciliary body face. This case series, of medication-induced angle-closure crisis, suggests that plateau iris configuration is a shared anatomical feature in the development of topiramate-induced ciliochoroidal effusions.

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Bilateral, Simultaneous, Acute Angle Closure Glaucoma in Pseudophakia Induced by Chlorthalidone

Case Reports in Ophthalmological Medicine ◽

10.1155/2016/3713818 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Indra Durai ◽

Mrunali Mohan Dhavalikar ◽

Chandran Prem Anand ◽

Venkatraman Ganesh ◽

Ramaswami Krishnadas

Keyword(s):

Case Reports ◽

Crystalline Lens ◽

Acute Angle ◽

Angle Closure Glaucoma ◽

Angle Closure ◽

Systemic Hypertension ◽

Drug Induced ◽

Idiosyncratic Reaction ◽

Acute Angle Closure ◽

Acute Angle Closure Glaucoma

Purpose. To report two persons with acute, bilateral, and simultaneous angle closure glaucoma in pseudophakia secondary to uveal effusions induced by administration of chlorthalidone.Methods. Case reports.Results. Bilateral shallow anterior chambers and high intraocular pressure with decline in visual acuity were reported in two patients within days of intake of chlorthalidone for systemic hypertension. Gonioscopy confirmed appositional angle closure while choroidal detachment and ciliochoroidal detachment were revealed on ultrasonographic studies. Discontinuing chlorthalidone and institution of aqueous suppressants to reduce IOP and cycloplegics reversed angle closure and glaucoma.Conclusions. Reports of angle closure glaucoma in pseudophakic eyes induced by idiosyncratic reaction to chlorthalidone confirms that osmotic changes in the crystalline lens has no role in the pathogenesis of drug induced glaucoma and reaffirms that glaucoma is secondary to ciliochoroidal detachment and ciliary body rotation and edema.

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Gonioscopy and Ultrasound Biomicroscopy in the Detection of Angle Closure in Patients with Shallow Anterior Chamber

Chinese Medical Sciences Journal ◽

10.1016/s1001-9294(14)60071-7 ◽

2014 ◽

Vol 29 (4) ◽

pp. 204-207 ◽

Cited By ~ 2

Author(s):

Shan-shan Cui ◽

Yan-hong Zou ◽

Qian Li ◽

Li-na Li ◽

Ning Zhang ◽

...

Keyword(s):

Anterior Chamber ◽

Ultrasound Biomicroscopy ◽

Angle Closure ◽

Shallow Anterior Chamber

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Ultrasound biomicroscopy in acetazolamide-induced myopic shift with appositional angle closure

Arquivos Brasileiros de Oftalmologia ◽

10.5935/0004-2749.20170080 ◽

2017 ◽

Vol 80 (5) ◽

Cited By ~ 3

Author(s):

Julio Daniel Grigera ◽

Emilio Daniel Grigera

Keyword(s):

Ultrasound Biomicroscopy ◽

Angle Closure ◽

Myopic Shift

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Bilateral Angle Narrowing and Acute Myopia Induced by Indapamide: A Case Report

Case Reports in Ophthalmological Medicine ◽

10.1155/2018/1486128 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Ana Catarina Pedrosa ◽

Joana Rodrigues Araújo ◽

João Paulo Macedo ◽

Sérgio Estrela Silva ◽

António Melo ◽

...

Keyword(s):

Case Report ◽

Clinical Case ◽

Clinical Manifestations ◽

Pressure Control ◽

Ultrasound Biomicroscopy ◽

Acute Onset ◽

Angle Closure ◽

Anterior Chamber Angle ◽

Ciliochoroidal Effusion ◽

Blurry Vision

Purpose. To describe a clinical case of indapamide induced bilateral angle narrowing and acute myopia. Materials and Methods. Clinical case report. Results. A 37-year-old Caucasian emmetropic man presented to the Emergency Department with complaints of acute-onset bilateral blurry vision, nine days after starting treatment for arterial hypertension with a combination of indapamide and amlodipine. Clinical examination revealed the presence of myopia and appositional closure of the anterior chamber angle. Ultrasound biomicroscopy and mode B ultrasonography disclosed bilateral ciliochoroidal effusion with anterior rotation of the ciliary body and iridocorneal angle narrowing. After intraocular pressure control with brimonidine and timolol, and replacement of indapamide/amlodipine by amlodipine only, the patient was discharged. Complete resolution of the clinical manifestations was observed after three weeks, with no sequelae. Conclusions. Indapamide may cause acute myopia and angle closure secondary to ciliochoroidal effusion that are fully reversible after drug withdrawal, as long as timely diagnosis is established. Therefore, indapamide, as well as other sulfonamide-derived drugs, must always be considered in the differential diagnosis of acute myopia and angle closure.

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