Acute angle closure and myopia shift after topiramate use: Case report and literature review

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A 22-year-old female patient presented with a 1-day history of bilateral visual loss after topiramate use. Visual acuity was counting fingers at 2 m with high myopia detected on autorefractometry in both eyes. The anterior chamber angles were graded as 1 by Van Herrick’s method, and the scleral spur was barely visible on gonioscopy. Intraocular pressures were 50 and 56 mm Hg in the right and left eyes, respectively. Topiramate was discontinued, while topical tropicamide, dexamethasone, dorzolamide, and timolol were administered. The pretreatment axial lengths were 22.53 and 22.48 mm in the right and left eyes, respectively, while the post-treatment values were 22.43 and 22.45 mm. Pretreatment anterior chamber depths were 2.20 and 2.10 mm in the right and left eyes, respectively, increasing to 3.09 and 3.11 mm after treatment. The pretreatment lens thickness and vitreous length were 3.88 and 16.46 mm in the right eye and 3.32 and 17.07 mm in the left eye, respectively. After treatment, these values decreased to 3.38 and 15.96 mm in the right eye and 3.25 and 16.10 mm in the left eye. Thickening of the retina-choroidal complex and expansion of Tenon’s space were observed on the B-scan. Iris bombe, peripheral iridocorneal apposition, and a higher lens vault were noted with a marked reduction in angle opening distance and trabecular iris space area on anterior segment optical coherence tomography. Pretreatment central corneal thickness and lens vault were 674 and 458 μm, respectively, decreasing to 559 and −279 μm after treatment. Refractive status, intraocular pressures, and imaging findings were restored to normal within 2 weeks. Increased lens thickness and vitreous length, along with a higher lens vault, were the possible pathogenic mechanisms.