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

Yong Koo Kang,Dong Ho Park,Byeong Jae Son,Jae Pil Shin

doi:10.1186/s12886-019-1230-y

Yong Koo Kang, Dong Ho Park + Show 2 more

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https://doi.org/10.1186/s12886-019-1230-y

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Journal: BMC Ophthalmology	Publication Date: Nov 4, 2019
Citations: 8	License type: open-access

Affiliation: Kyungpook National University

Abstract

BackgroundTo report five cases of acute drug-induced angle closure and transient myopia with ciliochoroidal effusion and to analyze angiographic findings of these cases.MethodsThis 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).ResultsFive 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).ConclusionsThe 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.

Highlights

To report five cases of acute drug-induced angle closure and transient myopia with ciliochoroidal effusion and to analyze angiographic findings of these cases
Bilateral angle closure glaucoma with ciliochoroidal effusion and transient myopia is a well-known complication of sulfa drugs such as topiramate [1,2,3], hydrochlorothiazide [4,5,6], acetazolamide [6, 7], methazolamide [8, 9], and indapamide [10]
For drug-induced angle closure glaucoma with ciliochoroidal effusion, there is no known report of angiographic findings, including indocyanine green angiography (ICGA), the main pathology of this

Summary

Introduction

To report five cases of acute drug-induced angle closure and transient myopia with ciliochoroidal effusion and to analyze angiographic findings of these cases. Bilateral angle closure glaucoma with ciliochoroidal effusion and transient myopia is a well-known complication of sulfa drugs such as topiramate [1,2,3], hydrochlorothiazide [4,5,6], acetazolamide [6, 7], methazolamide [8, 9], and indapamide [10]. Cases of bilateral angle closure glaucoma and transient myopia with ciliochoroidal effusion induced by mefenamic acid [11] or anorexiants, including phendimetrazine tartrate and ephedrine [12], have been reported. We describe a series of five patients who presented with acute bilateral angle closure and transient myopia with ciliochoroidal effusion after use of topiramate, methazolamide, mefenamic acid and phendimetrazine tartrate. We summarize the characteristic features of angiographic findings of these patients and suggest the underlying pathogenesis of this condition

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