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Batman in the anterior chamber

Retracting fibrin on anterior segment optical coherence tomography

Reddy, Subhakar; Tyagi, Mudit; Govindhari, Vishal

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Indian Journal of Ophthalmology: September 2020 - Volume 68 - Issue 9 - p 1972
doi: 10.4103/ijo.IJO_1243_20
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A 45-year-old female developed a bilateral grade 4 anterior chamber (AC) inflammation after using topiramate 100 mg once daily for 1 week for her epilepsy. Her best-corrected visual acuity (BCVA) was counting fingers close to face (CFCF) in both eyes. Topiramate was discontinued[1] and she was started on intense topical steroids and cycloplegics. At 1 week, her BCVA improved to 20/60 and AC showed reduced reaction with retracting fibrin [Fig. 1a]. An AS-OCT showed multiple hyperreflective dots[2] (cells) surrounded by a boundary of fused hyperreflective dots [Fig. 1b] suggestive of enmeshed coagulum of fibrin (yellow arrow) in the shape of a bat.

Figure 1
Figure 1:
(a) Diffuse slit lamp photograph showing fibrinous anterior uveitis, (b) AS-OCT showing retracting fibrin (yellow arrow) in the shape of a bat

Our case demonstrates that topiramate cause drug-induced uveitis and angle closure.[1] Anterior segment OCT can be used in the documentation of AC reaction and can also aid in quantification along with existing slit lamp grading.[2]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

1. Jabbarpoor Bonyadi MH, Soheilian R, Soheilian M. Topiramate-induced bilateral anterior uveitis associated with hypopyon formation Ocular Immunol Inflamm. 2011;19:86–8
2. Li Y, Lowder C, Zhang X, Huang D. Anterior chamber cell grading by optical coherence tomography Invest Ophthalmol Vis Sci. 2013;54:258–65 Published 2013 Jan 9
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