DISTINCTIVE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY AND INDOCYANINE GREEN ANGIOGRAPHY IMAGING PATTERNS IN TOPIRAMATE-INDUCED CHOROIDAL EFFUSION.

Purpose: The aim of this study was to describe novel findings seen on optical coherence tomography angiography (OCTA) and indocyanine green angiography in a young male patient presenting with bilateral topiramate-induced choroidal effusion.

Methods: This is a retrospective case report. A comprehensive ophthalmic examination was conducted and multimodal imaging techniques, including B-scan ultrasound, OCT, OCTA, and indocyanine green angiography were analyzed.

Results: A male patient in his 30s presented with a myopic shift due to bilateral choroidal effusion induced by a medication containing topiramate prescribed for weight loss. Indocyanine green angiography showed multiple hypofluorescent spots within the choroid corresponding to areas of reduced OCTA flow signal in both the inner and deeper en face choroidal slabs. Symptoms and abnormal imaging findings resolved within 5 days of discontinuing the medication.

Conclusion: Findings observed with OCTA and indocyanine green angiography together suggest multifocal reversible areas of reduced choroidal vascular flow occurring in a topiramate-induced choroidal effusion. The authors propose that this transient hypoperfusion is due to compression from deeper choroidal vessels with a congested choroid.