Angiographic Features of Drug-Induced Bilateral Angle Closure and Transient Myopia with Ciliochoroidal Effusion

Abstract Background: To report five cases of acute drug-induced bilateral angle closure and transient myopia with ciliochoroidal effusion, and to suggest a pathogenesis for this condition based upon angiography. Methods: This study is an observational case series. Five patients with acute drug-induced angle closure with ciliochoroidal effusion were examined by ultrasound biomicroscopy, fluorescein angiography, and indocyanine green angiography (ICGA). Results: Five patients presented with bilateral visual impairment and ocular pain after treatment with mefenamic acid, phendimetrazine tartrate, topiramate, or methazolamide. All patients presented a shallow anterior chamber and elevated intraocular pressure in both eyes. They showed a myopic shift from -0.5 to -17.0 diopters. Ultrasound biomicroscopy revealed annular ciliochoroidal effusions with diffuse thickening of the ciliary body in all cases. Rapid clinical improvement occurred in all patients after discontinuing the suspected drugs. ICGA findings were classified into two major signs (hypofluorescent dark spots and hyperfluorescent pinpoints) and three minor signs (early choroidal stromal vessel hyperfluorescence and leakage, diffuse hyperfluorescence of the choroid, and tortuous and dilated retinal vessels). Conclusions: The basic mechanism of pathogenesis involved an idiosyncratic reaction in uveal tissue to systemic drugs. Angiography showed that accumulation of extravascular fluid in the ciliochoroidal layer had a major role in pathogenesis. Angiography could therefore be a useful method to examine the pathophysiology of this condition by imaging of the choroidal layer.