Acetazolamide-Induced Bilateral Ciliochoroidal Effusion Syndrome in Plateau Iris Configuration

Xiaofei Man, Raquel Costa, Bernadete M Ayres, Sayoko E Moroi, Xiaofei Man, Raquel Costa, Bernadete M Ayres, Sayoko E Moroi

Abstract

Purpose: Our purpose is to describe a 60-year-old male, who has plateau iris configuration and developed bilateral ciliochoroidal effusion syndrome after ingestion of acetazolamide.

Observations: Our case was a research participant in a multi-center clinical study (ClinicalTrials.gov NCT01677507). During the course of this study, he was treated with a single dose of acetazolamide (500 mg), and seven days later treated with latanoprost one drop daily at bedtime both eyes for seven days, and then was administered another dose of acetazolamide (500 mg). Several hours later he complained of blurred vision in the distance and mild headache. On examination, he had a myopic shift, intraocular pressures of 36 mmHg in right eye and 35 mmHg in left eye, shallow anterior chambers both eyes, and occluded angles by gonioscopy both eyes. An echographic exam confirmed the bilateral ciliochoroidal effusion syndrome. He was treated by no further dosing of acetazolamide and started on timolol, atropine and prednisolone. Two weeks later, the bilateral choroidal effusion and acute angle closure were resolved. Repeat echography showed plateau iris configuration.

Conclusions and importance: To the best of our knowledge, drug-induced bilateral ciliochoroidal effusion syndrome has not been reported with acetazolamide in plateau iris configuration.

Keywords: Acetazolamide; Angle closure; Ciliochoroidal effusion; Drug reaction; Plateau iris; Ultrasound Biomicroscopy.

Figures

Fig. 1
Fig. 1
Echography of ciliochoroidal effusion syndrome. Ultrasound biomicroscopy (UBM) showed shallow anterior chamber (A) and anterior rotation of the ciliary body with angle closure (B). B-scan demonstrated 360° shallow choroidal effusions in the posterior segment (C). After treatment and resolution of ciliochoroidal effusion, repeat UBM showed deep anterior chamber and open angle (D) and plateau iris configuration with anterior rotation of the ciliary body and absence of the ciliary sulcus (E). B-scan showed resolution of shallow posterior choroidal effusion (F).
Fig. 2
Fig. 2
Echography of different anterior angle anatomies. (A) Normal anatomy demonstrating an open angle, iris root insertion at the ciliary body-sclera junction, and open ciliary sulcus. (B) Typical plateau iris configuration (PIC) anatomy demonstrating clear iris root angulation with peripheral narrow angle, iris root insertion near the ciliary body-sclera junction, anterior rotation of the ciliary process, and narrow ciliary sulcus. (C) Atypical PIC anatomy demonstrating an open angle, iris root insertion on top of the ciliary process, anterior rotation of the ciliary process and absent ciliary sulcus, which is hallmark of PIC. (D) Plateau iris syndrome demonstrating peripheral angle closure with iris root insertion on the ciliary process, anterior rotation of the ciliary process, and absent ciliary sulcus.

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