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

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.

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

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.

Induced Myopia Secondary to Blunt Trauma

A 28-year-old young man presented with sudden and severe visual loss in the left eye, starting three days ago following blunt head trauma from a closed fist. Vision was not improved to better than 0.4 in the left eye. Slit lamp examinations revealed asymmetric anterior chamber depth (ACD) with shallow ACD in the left eye. The key learning in this report is the use of anterior segment optical coherence tomography (AS-OCT) to better document the anterior segment changes following the blunt trauma. AS-OCT was used to visualize the forward displacement of the iris-crystalline lens diaphragm secondary to ciliary body anterior rotation and ciliochoroidal effusion. There was a temporary myopic shift about 7.00 D which resolved after 15 days.