Bilateral acute angle closure glaucoma and myopic shift by topiramate-induced ciliochoroidal effusion: case report and literature review

PurposeTo report two cases of ciliochoroidal effusion after the usage of topiramate.CasesTwo middle-aged women experienced sudden onset of acute glaucoma and acquired myopia after taking topiramate. Ultrasound biomicroscopy demonstrated bilateral ciliochoroidal effusion and angle closure. The A-scan ultrasonography revealed shallow anterior chamber and thick lens. After the treatmentand drug withdrawal, intraocular pressure, refractive status and angle anatomy returned to normal and there was resolution of ciliochoroidal effusion. During the clinical course, the anterior chamber depth (ACD) increased from 2.02 to 3.30mm (1.28mm of changes) OD and from 1.94 to 3.36mm (1.42mm of changes) OS. The lens thickness (LT) became thinner from 4.53 to 4.31mm (0.22mm of changes) OD and from 4.59 to 4.30mm (0.29mm of changes) OS in the first case. In the second case, the ACD increased from 2.33 to 3.07mm (0.74mm of changes) OD and from 2.30 to 3.05mm (0.75mm of changes) OS. The LT became thinner from 4.42 to 4.27mm (0.15mm of changes) OD and from 4.38 to 4.26mm (0.12mm of changes) OS. The forward displacement of the lens-iris diaphragm contributed more to the shallowness of the anterior chamber than the thickening of the lens itself (only accounting for 20%).ConclusionTopiramate-induced bilateral acute angle closure glaucoma and myopic shift was due to ciliochoroidal effusion which resulted in thicker lens and shallow anterior chamber. The later was mainly due to anterior displacement of the lens-iris diaphragm.