Acquired myopia followed by acquired hyperopia due to serous neurosensory retinal detachment following topiramate intake

Abstract

Purpose: To report a patient with fluctuating refraction following the use of oral topiramate. Case report: A 38-year-old male patient was diagnosed elsewhere with sudden-onset-acquired myopia, high intraocular pressure, and bilateral angle closure glaucoma for which he underwent laser peripheral iridotomy in both eyes and was started on topical antiglaucoma medications and topical steroids following laser peripheral iridotomy. He was referred for ultrasound biomicroscopy, which showed bilateral ciliary effusion. Ultrasound of eyes revealed choroidal thickening. On further questioning, he was noted to have taken oral topiramate for 7 days, which he stopped a week before the ocular symptoms. He was started on atropine, on which the acquired myopia resolved, the anterior chamber deepened, and the intraocular pressure came down. After 4 days, he developed acquired hyperopia in the left eye. Neurosensory retinal detachment at the posterior pole was documented with optical coherence tomography. The fluorescein angiography showed few ink-blot leaks and one smokestack leak in the left eye. The neurosensory detachment resolved spontaneously with an uncorrected visual acuity of 6/6 in either eye. Conclusion: A unique case of central serous chorioretinopathy following oral intake of topiramate is presented. This patient had also received laser peripheral iridotomy and topical steroids following the peripheral iridotomy.