Ciliochoroidal Effusion Syndrome Research Articles

Acute bilateral glaucoma related to uveal effusion syndrome associated with topiramate

AbstractPurpose: Drugs mostly sulfa‐related compounds, have produced uveal effusions, forward rotation of the iris‐lens diaphragm, transient myopia, and secondary angle closure. It has been recently encountered one case in which uveal effusions have occurred after administration of topiramate, a new anticonvulsant medication.Methods: A 54‐year‐old woman was seen in our emergency department with severe headaches, progressively blurry vision and photophobia in both eyes starting that morning. On examination, her visual acuity was hand movement in both eyes. Central corneal edema was observed, narrow chamber and anterior lens‐iris complex displacement with an unreactive middle pupil in both eyes. The funduscopic examination was difficult to assess due to the media opacity. Intraocular pressure measured with an applanation tonometer was 45 mm of mercury (mmHg) in the right eye and 50 mmHg in the left eye. Her medications included topiramate which she had started 2 weeks prior to initial examination due to headaches followed by neurology.Results: Topiramate‐induced angle closure has even been described as an idiosyncratic reaction in patients with normal depth of anterior chamber. The drug causes a prostaglandins increasement that trigger ciliary body edema at the local level but without acting at the systemic level. Ultrasound biomicroscopy shows the presence of a ciliochoroidal effusion syndrome, edema and the ciliary body anterolateral rotation, with zonular relaxation, changes that lead to iris‐lens diaphragm anterior displacement and, as a consequence, narrowing of the responsible anterior chamber with an acute glaucoma crisis.Conclusions: Topiramate is a sulfamate monosaccharide and belongs to a new generation of antiepileptic drugs, widely prescribed throughout the world as treatment of generalized tonic–clonic seizures and partial seizures. Prophylaxis of migraine, bipolar disorder, depression and neuropathic pain are other recent indications of its use. Bilateral acute glaucoma due to uveal effusion syndrome should be considered as an infrequent complication of topiramate use.References.1. Prithvi S. Sankar, MD; Louis R. Pasquale et al. Uveal Effusion and Secondary Angle‐Closure Glaucoma Associated With Topiramate Use. Arch Ophthalmol. 2001;119(8):1210–1211.

Reply of the article: Contribution of the Visante® OCT and B-scan ultrasonography in the diagnosis and follow up of a bilateral ciliochoroidal effusion syndrome induced by topiramate

Angiosarcoma is a rare complication of both functioning and nonfunctioning fistulas. It is an aggressive soft tissue sarcoma arising from vascular or lymphatic endothelial cells. We report a case of angiosarcoma from a nonfunctional fistula in a kidney transplantation patient receiving immunosuppressive drugs. The patient had presented with arm pain mimicking a thrombosed arteriovenous fistula.

Comment on: “Contribution of the Visante® OCT and B-scan ultrasound in the diagnosis and follow up of a topiramate-induced bilateral ciliochoroidal effusion syndrome”

Comment on: “Contribution of the Visante® OCT and B-scan ultrasound in the diagnosis and follow up of a topiramate-induced bilateral ciliochoroidal effusion syndrome”

Case Report of a 67-Year-Old Man with Zonisamide-Induced Ciliochoroidal Effusion Syndrome

Abstract Purpose Review the second reported case of zonisamide induced angle closure. Case Report Patient presentation of ciliochoroidal effusion syndrome secondary to zonisamide. Conclusions Prompt recognition and management of ciliochoroidal effusion syndrome is paramount as newer sulfonamide medications are introduced.

Contribution of the Visante® OCT and B-scan ultrasound in the diagnosis and follow up of a topiramate-induced bilateral ciliochoroidal effusion syndrome

A 45 year-old man with bilateral acute angle-closure and myopia after starting treatment with topiramate, secondary to alcohol and heroin dependence. Using Visante® OCT (Optical Coherence Tomography) and B-scan Ultrasound he was diagnosed with bilateral ciliochoroidal effusion as the pathophysiological mechanism. Topiramate was stopped and ocular hypotensive therapy with a topical cycloplegic and corticosteroids were started, resolving ciliochoroidal effusion syndrome. Visante® OCT and B-scan Ultrasound are useful tools for the diagnosis and follow-up of patients with acute angle-closure and myopia due to topiramate. As a result of broad spectrum of indications for topiramate, physicians and ophthalmologists should be aware of the possible ophthalmological manifestations attributable to this drug.

Bilateral acute myopia and angle-closure glaucoma in a migraine patient receiving Topiramate: a case report

We present a case of topiramate-induced angle-closure glaucoma that was treated with cycloplegia. A 40-year-old woman with a history of migraine presented with bilateral acute onset of blurred vision and headache. She had been prescribed 50 mg of oral topiramate bid for migraine prophylaxis 10 days prior to her presentation. On her ocular examination visual acuity was 20/20 with a myopic correction of -4.0 diopters in both eyes. Bio-microscopic examination revealed bilateral shallow peripheral anterior chambers. Intraocular pressures were 37 OD and 36 OS. On gonioscopic examination bilateral 360 degrees of angle closure was seen. B-scan ultrasonography showed peripheral choroidal effusions. The mainstay of the treatment for topiramate induced secondary angle closure is cyloplegia. Whenever a case of bilateral acute angle-closure glaucoma associated with myopia and shallow anterior chambers is encountered, ciliochoroidal effusion syndrome induced by drugs should be considered in the differential diagnosis.

Topiramate associated non-glaucomatous visual field defects

We report a 34-years-old woman who presented with bilateral incongruous inferior visual field defects after the commencement of topiramate for management of migraine. Investigations did not reveal any underlying angle closure glaucoma, reported in current literature to be associated commonly with topiramate associated visual field defects. The changes in the peripheral visual fields gradually improved over several months after the medication was withdrawn. There were only minor changes persistent on the left side on a background of pre-existing myopia and keratoconus. Visual field deficits secondary to topiramate are more commonly attributed to angle closure glaucoma due to ciliochoroidal effusion syndrome. In such instance, the visual field defects are associated with considerable pain due to raised intra-ocular pressure. There have also been reports of visual scotomas due to retinal damage and maculopathy in patients taking topiramate. It is worthwhile to obtain a baseline perimetry in patients being considered for topiramate therapy in order to gauge any changes in their peripheral field of vision during the treatment. Changes in visual fields during the course of medication use and after cessation can be easily compared especially if there are other possible confounders such as refractive errors or a history of migraine.

Peripheral Serous Pigment Epithelial Detachment and Retinal Detachment Presumably Associated with Hydrochlorothiazide Use

Sulfa-derivatives have been associated with acute transient myopia, angle closure glaucoma (ACG), and ciliochoroidal effusion syndrome (CCES) but not with pigment epithelial detachment (PED) or serous retinal detachment (SRD) [1], [2], [3], [4]. We report a case with features of CCES as well as a peripheral serous PED (SPED) and SRD which developed while taking hydrochlorothiazide, a sulfa-derivative.

Headache in migraine patients receiving topiramate: a mere migraine attack or a harbinger of ciliochoroidal effusion syndrome?

Headache in migraine patients receiving topiramate: a mere migraine attack or a harbinger of ciliochoroidal effusion syndrome?

Topiramate and the vision: a systematic review.

Background and purposeTopiramate (TPM) is a sulfa-derivative monosaccharide that is used mainly for treating epilepsy and preventing migraine. Within the gamut of side effects attributable to this drug, ophthalmologic manifestations are of crucial importance. In this study, for the first time, the aim was to provide a systematic literature review regarding this issue.MethodsFor the time period 1996–2011, a PubMed search was made for the studies concerning the adverse/beneficial effects of TPM on vision. Overall, 404 citations out of a total of 2756 TPM-related studies were examined for relevance.ResultsA total of 74 relevant studies were reviewed, 65 of which comprise small observational studies describing the ophthalmic side effects of TPM in 84 patients. Of these patients, 66 were affected by ciliochoroidal effusion syndrome as the cardinal ocular side effect of TPM (17 cases of myopic shift and 49 cases of angle closure glaucoma). A comprehensive statistical analysis is provided on these 66 subjects. Other rare side effects of TPM on the vision were also reviewed, including massive choroidal effusion, ocular inflammatory reactions, visual field defects, probable effects on retina, cornea, and sclera, and neuroophthalmologic complications. In addition, a framework is provided to classify these results.DiscussionDue to the expanding spectrum of indications for the administration of TPM, neurologists and psychiatrists should be aware of its diverse ocular side effects. In conclusion, ocular complications following this drug should be taken seriously and be subjected to ophthalmic counseling.

Ciliochoroidal Effusion Syndrome Associated with Posterior Scleritis

To determine the cause of angle-closure glaucoma in a case of posterior scleritis. The patient was a 65-year-old woman with unilateral acute angle-closure glaucoma who did not respond to laser iridotomy. Slit-lamp examination demonstrated a shallow anterior chamber in the left eye. Intraocular pressure was 22 mmHg even after application of two antiglaucoma eye-drop preparations. B-scan ultrasonography demonstrated scleral thickening and choroidal detachment in the left eye. Ultrasound biomicroscopy showed a shallow anterior chamber with angle closure, annular ciliochoroidal effusion with ciliary body edema, and an anterior rotation of the ciliary body. After instillation of cycloplegics, the ciliary body and ciliary processes rotated posteriorly, resulting in the release of the pressure on the iris. These changes led to the opening of the angle and subsequent normalization of intraocular pressure. A diagnosis was made of ciliochoroidal effusion syndrome associated with posterior scleritis. Patients with posterior scleritis can develop ciliochoroidal effusion syndrome, which can lead to angle-closure glaucoma. The therapeutic strategy for acute angle-closure glaucoma induced by ciliochoroidal effusion syndrome differs completely from that for acute angle-closure glaucoma with pupillary block. In the case of ciliochoroidal effusion syndrome, it is important to relieve the compression of the angle by the iris by displacing the lens-iris diaphragm posteriorly by cycloplegics.