Late Acute Myopia Syndrome Induced by Combination of Sulfonamide Drugs

Abstract

We present a case of late acute myopia syndrome following discontinuation of treatment with a combination of sulphonamide drugs. To the best of our knowledge, this is the first reported case with such a presentation, and suggests that the pathophysiological basis for the acute myopia syndrome is a rapid decrease in serum carbonic anhydrase inhibitors levels which may lead to a rebound increase in the production of aqueous humor and accumulation of suprachoroidal fluid. It is further postulated that there may be a cumulative effect of sulphonamide drug use on carbonic anhydrase activity in the ciliary body epithelium of susceptible individuals.

Sumatriptan-induced angle-closure glaucoma

“…Multifactorial alteration of choroidal vascular permeability may also trigger the drug-induced malignant glaucoma. [3] The 5-HT1B/1D receptor agonist sumatriptan may also have an effect on the blood vessels, and this may be another cause of the sumatriptan-induced bilateral AAC glaucoma.…”

Topiramate-induced maculopathy in IgG4-related disease

“…This was associated with a resolution of bilateral retinal macula striae and improved vision. Kozner et al 12 described the development of an acute myopia syndrome secondary to topiramate discontinuation, a dose decrease. Kozner et al 12 hypothesized that sudden changes in the plasma levels of topiramate may result in abnormal carbonic anhydrase activity and subsequent accumulation of fluid within the uveal tissue.…”

Comment on ‘Topiramate maculopathy secondary to dose titration: first reported case’

“…In contrary, in 2014 we shared our experience of acute myopia syndrome secondary to topiramate discontinuation, a dose decrease. 2 Therefore, we assume that an increase as well as decrease of dosing may have a common physiological mechanism through which both ocular adverse effects are mediated.…”