A Rare Case of Unilateral Progressive Cataract in a Young Patient Receiving Topiramate

This case report presents an instance of unilateral cataract formation and its rapid progression following topiramate-induced bilateral acute angle closure. An 18-year-old female diagnosed with acute angle closure in both eyes had started treatment on the previous day at another healthcare facility. The patient presented with complaints of pain, sudden diminution of vision, excessive watering, and photophobia (both eyes) and reported the use of topiramate for headache for 10 days. There was no past history of decreased vision, trauma, uveitis, or use of steroids. Topiramate-induced bilateral secondary angle closure attack was the presumptive diagnosis. Topiramate use was stopped, and antiglaucoma drugs, topical cycloplegic, and topical steroids were started. On 1-day follow-up, clearer cornea and peripheral anterior capsular lenticular opacity of the right eye were observed. Gonioscopy showed closed angles. Anterior segment optical coherence tomography showed forward movement of the iris-lens diaphragm and closed angles. B-scan showed ciliochoroidal effusion in the right eye and normal left eye. At 2-month follow-up, formed anterior chamber and posterior subcapsular cataract in the right eye were seen. There were no lenticular changes in the left eye. Definite progression of cataract from day-1 to 2-month follow-up was seen in the right eye. To our knowledge, this is the first report of the rapid progression of cataract following topiramate-induced secondary angle closure in a young patient warranting surgical intervention.

Keywords: Ciliochoroidal effusion; Glaukomflecken; Progression of cataract; Secondary angle closure; Topiramate.