Bilateral Acute Glaucoma Research Articles

Topiramate induced bilateral angle closure with anterior uveitis – A masquerade in a migraine patient

Topiramate (TPM), a sulphonamide derivative, is a commonly used medication by physicians and psychiatrists. Topiramate-induced angle closure glaucoma (ACG) and TPM-induced myopic shift are reported ocular adverse reactions of this drug. We report here a case of TPM-induced ciliochoroidal effusion presenting as bilateral acute angle closure with anterior uveitis and myopic shift in a patient with migraine. The acute and often bilateral severe visual deterioration in patients on TPM therapy cannot only be disturbing to the patient but can also be a challenge to the attending ophthalmologist to manage. We highlight the confusing presentation leading to the initial misdiagnosis of bilateral ACG and challenges in the management of this potentially sight-threatening condition.

ACETAZOLAMIDE INDUCED SECONDARY ANGLE CLOSURE GLAUCOMA: A RARE CASE REPORT

Introduction : Drugs such as topiramate, acetazolamide, methazolamide, buproprion, and trimethoprim- sulfamethoxazole potentially cause an elevation of IOP. Drug-induced glaucoma may be an ophthalmic emergency if not treated promptly and can results in permanent visual loss.
 Case Illustration : A 36-years-old female came to Glaucoma Unit at Cicendo National Eye Hospital with progressive blurred vision since 1 year ago, worsening in the past six months. Accompanying symptoms included pain, headache, halo, and conjunctival hyperemia. She had been diagnosed with glaucoma and received timolol maleate, acetazolamide, and glycerin. Seven days later, her visual acuity worsened to 3/60 ph 0.15 RE and 2/60 ph 0.15 LE, with high IOP in both eyes, with the higher IOP being >30 mmHg. The cup-to-disc ratio was 0.3 RE and 0,8 LE. The anterior segment showed shallow anterior chamber, mid-dilated pupil, and conjunctival injection (Figure 1.). Gonioscopy examination showed Schwalbe line of both eyes (Figure 2.). Acetazolamide was stopped, and one week later the condition resolved (Figure 3.).
 Discussion : Secondary angle closure glaucoma caused by acetazolamide is important to consider because most people tolerate acetazolamide well. The mechanism of closed-angle glaucoma can be pupillary block and non-pupillary block. Non-pupillary block is caused by thickening, forward movement the iris-lens diaphragm, rotation of the ciliary body, and choroidal effusion. This process is an idiosyncratic reaction to certain systemic drugs.
 Conclusion : Few cases were reported about secondary bilateral angle closure glaucoma due to acetazolamide. Treatment of angle closure glaucoma involves stopping acetazolamide

Sturge-Weber Syndrome Associated with Bilateral Angle-closure Glaucoma in a Young Adult

Sturge-Weber syndrome (SWS) is a phakomatosis involving the eyelids, conjunctiva, choroid and retina. The mechanism ofglaucoma in SWS involves developmental anomaly of the anterior chamber angle and elevated episcleral venous pressure.Here, we present a case of Roach’s type II SWS with bilateral angle-closure glaucoma (ACG) in a young adult, which to thebest of our knowledge, is the first-of-its-kind report in the literature. Though unusual, ACG may occur in young adults too.However, the underlying causes that make them develop the ACG are poorly understood. We also highlight the importanceof comprehensive clinical examination and appropriate investigations for early detection and proper treatment of such youngpatients with ACG.

Bilateral angle closure glaucoma with retinitis pigmentosa in young patients: case series

BackgroundTo report the ocular characteristics and management of three cases of retinitis pigmentosa (RP) concurrent primary angle closure glaucoma (PACG).Case presentationThree middle-aged patients presenting with diminished vision, high intraocular pressure (IOP), and typical fundus manifestations of RP were clinically evaluated. The individualized treatment was based on the ocular conditions of each case. A novel genetic alteration in ZNF408 was identified in one patient. Two patients with short-axial eyes received unilateral combined trabeculectomy, cataract surgery, and Irido-zonulo-hyaloid-vitrectomy. One of them had a subluxated lens, managed with a capsular tension ring implantation. Their contralateral eyes, respectively, underwent laser peripheral iridotomy (LPI) and transscleral cyclophotocoagulation. The third patient underwent bilaterally combined laser peripheral iridoplasty, LPI, and medication. Ultimately, all patients achieved the target IOP during a two-year follow-up.ConclusionYoung patients with RP may have a risk of developing angle closure glaucoma, and conversely, patients with angle closure glaucoma at younger age should be aware of the presence of RP. Therefore, routine gonioscopy and IOP monitoring are required for RP patients, and detailed fundus examinations are warranted for young PACG patients.

Drug induced secondary angle closure glaucoma- A case series

: We report 3 cases with acute bilateral angle closure glaucoma following intake of oral chlorthalidone, mefenamic acid, topiramate. : Case series. : All patients developed bilateral acute onset painful defective vision with shallow anterior chamber, raised intraocular pressure. Gonioscopy revealed bilateral occludable angle and ultrasonogram B scan showed shallow choroidal detachment, suggestive of drug induced non pupillary block secondary angle closure glaucoma. All patients were managed by discontinuation of causative drug and started on topical antiglaucoma medication and cycloplegic drug. : we would like to bring this potentially sight threatening and reversible ophthalmic condition to general physician, which can be managed effectively by timely referral and intervention.

Topiramate-induced acute angle-closure glaucoma: A case report and review of literature

Drug-induced angle-closure glaucoma is an emergency associated with potentially vision threatening side effects. There are various classes of drugs which induce acute angle-closure glaucoma. Topiramate is an oral sulfa-based drug used for seizure, migraine, and neuropathic pain. There are published case reports of topiramate-induced angle-closure which can mimic acute angle-closure glaucoma. We present a case of a 32-year-old female who developed bilateral angle-closure glaucoma secondary to topiramate.

Bilateral secondary angle-closure glaucoma and ciliochoroidal effusion as an initial manifestation of systemic lupus erythematosus.

Bilateral secondary angle-closure glaucoma and ciliochoroidal effusion as an initial manifestation of systemic lupus erythematosus.

Acute Bilateral Angle-Closure Glaucoma Related to Intranasal Cocaine Abuse.

Acute Bilateral Angle-Closure Glaucoma Related to Intranasal Cocaine Abuse.

Закрытоугольная глаукома, иридохрусталиковый блок, цилиохориоидальная отслойка и транзиторная миопия на фоне приема топирамата

Topiramate is a sulphonamide derivative indicated in the treatment of epilepsy and migraine. In foreign scientific literature there are reported cases of topiramate-induced bilateral angle-closure glaucoma and acute myopia with ciliochoroidal effusion. Purpose. To evaluate outcomes of laser iridectomy in a patient with topiramate-induced angle-closure glaucoma and acute myopia with ciliochoroidal effusion. Material and methods. A case is reported of bilateral angle-closure glaucoma, iris-lens contact, ciliochoroidal detachment and acute myopia following topiramate for migraine treatment in a 32-year-old patient. Laser peripheral iridectomy was performed in the both eyes according to the standard technology (Nd:YAG laser Selecta Trio, Lumenis Ltd., Israel) to decrease IOP and restore visual functions. Results. After laser iridectomy, the examination showed normal IOP with no medication, ciliochoroidal effusion and induced myopic shift were relieved. Conclusion. Laser iridectomy is an effective and safe in the treatment of topiramate-induced angle-closure glaucoma, acute myopia, and ciliochoroidal detachment. It contributes to normalization of IOP and improvement of visual acuity. Key words: topiramate, angle-closure glaucoma, ciliochoroidal effusion, transient myopia.

BILATERAL ACUTE ANGLE CLOSURE GLAUCOMA IN A COVID 19 PATIENT FOLLOWING HEPARIN THERAPY- A CASE REPORT

Acute angle closure glaucoma is an ophthalmic emergency and can lead to blindness if left untreated. Pupillary block is the most common mechanism. Drug induced angle-closure has been reported to cause a significant proportion of these cases particularly in developing countries. The common drugs implicated are antidepressants, antipsychotics, antihistamines, anticonvulsants like topiramate, sulfa based drugs namely acetazolamide and hydrochlorothiazide, nebulized ipratropium bromide and salbutamol. Anticoagulants have also been reported to cause AACG in predisposed eyes As the COVID-19 pandemic has spread throughout the world, a high rate of thrombotic complications has been described, including deep vein thrombosis Although the mechanisms of thrombosis are unclear, anticoagulation with high doses of heparin has been proposed for these patients. Critically ill patients with COVID-19 develop life-threatening coagulopathy and thromboembolic complications that justify aggressive anticoagulation with close monitoring. We report a patient who developed bilateral angle closure glaucoma following heparin therapy who was misdiagnosed as having conjunctivitis by treating physicians which is an ocular manifestation of COVID 19.

Akutes Engwinkelglaukom und Effusionssyndrom nach Phakoemulsifikation

Eine 72-jährige Patientin entwickelte nach unkomplizierter Kataraktoperation ein beidseitiges sekundäres iridokorneales Engwinkelglaukom bei uvealem Effusionssyndrom. Als Ursache für die Entstehung des Effusionssyndroms konnte die postoperative Einnahme von Acetazolamid ausgemacht werden. Unter Berücksichtigung einer Sulfonamid-freien systemischen und lokalen drucksenkenden sowie antiinflammatorischen Therapie zeigte sich eine schnelle Befundbesserung. Der Fall verdeutlicht eine seltene, aber klinisch schwerwiegende unerwünschte Arzneimittelwirkung von Acetazolamid und zeigt effiziente Therapiemöglichkeiten auf.

Vision 20/20 Clinic

We describe a case of a 26 year old female who developed bilateral angle closure glaucoma associated with oral topiramate therapy and her follow up by Anterior Chamber Angle Optical Coherence Tomography (ACA-OCT) during her treatment.

A Case Report: Acute Myopia and Angle-Closure Glaucoma Attack after Topiramate use

Topiramate acetate is a commonly used drug prescribed by neurologists and psychiatrists for the treatment of various diseases including migraine. Topiramate therapy can cause a forward displacement of the iris-lens diaphragm which can result in acute bilateral angle-closure glaucoma and myopia. Common complaints include visual disturbances and eye pain. In this case report, we offered a patient who had a sudden loss of vision and severe eye pain due to acute myopia and angle-closure glaucoma after the use of topiramate for migraine. This case report aimed to increase awareness among neurologists, psychiatrists and ophthalmologists about the side effects that may occur with the use of topiramate.

Çocuk Bir Olguda İzole Mikro-sferofakiye Bağlı Her İki Gözde Açı Kapanması Glokomu

This case report presents diagnosis and management of a 9 year old child patient with bilateral angle closure glaucoma caused by isolated microspherophakia. Biomicroscopic examination was normal in both eyes except for shallow anterior chambers. Crystalline lens was located slightly forward into the anterior chamber causing a pupillary block in both eyes. The intraocular pressure was 45 mmHg in her right eye and 37 mmHg in her left eye. Both irido-corneal angles were closed in gonioscopic examination. For the treatment of this condition; we had performed clear crystalline lens extraction and implanted intraocular lens by trans-scleral fixation method for both eyes. After the surgery her best-corrected visual acuity was 20/20 in both eyes. Anterior chamber debth was normal in both eyes. Irido-corneal angle was open without peripheric anterior synechia formation. Lensectomy and intraocular lens implantation may be a possible treatment for microspherophakia related glaucoma.

Hydrochlorothiazide Sensitised Acetazolamide induced Bilateral Angle Closure Glaucoma with Choroidal Detachment after Cataract Surgery

Hydrochlorothiazide Sensitised Acetazolamide induced Bilateral Angle Closure Glaucoma with Choroidal Detachment after Cataract Surgery

Atorvastatin-Induced Fixed Drug Eruption Clopidogrel-Induced Acute Hepatitis Bilateral Angle-Closure Glaucoma Induced by Chlorthalidone Risk of Anaphylactic Reactions with Intravenous Iron Products Zonisamide-Induced DRESS with Eosinophilic Pneumonia.

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), discuss methods of prevention, and promote reporting of ADRs to the US Food and Drug Administration's (FDA's) MedWatch program (800-FDA-1088). If you have reported an interesting, preventable ADR to MedWatch, please consider sharing the account with our readers. Your report will be published anonymously unless otherwise requested. This feature is provided by the Institute for Safe Medication Practices (ISMP) in cooperation with the FDA's MedWatch program and Temple University School of Pharmacy. ISMP is an FDA MedWatch partner.

Topiramate-induced hypertensive uveitis and evolving Fuchs′ uveitis: A case report

We intend to report an interesting case of topiramate-induced bilateral uveitis (TIU) and angle closure glaucoma that gradually developed signs of Fuchs' uveitis (FU) in right eye after resolution of the attack. A 41-year-old female was started on oral topiramate for migraine following which she developed bilateral acute angle closure glaucoma and uveitis. She improved with topical and systemic steroids. As the attack resolved, her right eye started developing classical features of FU which were initially confused with viral uveitis. Patient was followed-up without steroids for 2 years. She remained asymptomatic in right eye and healthy systemically proving diagnosis of FU. We recommend high index of suspicion for FU in an asymptomatic low-grade uveitis even though typical features of FU are absent initially. Few weeks of observation may allow FU to manifest on its own, which will prevent unnecessary investigations and treatment.

Bilateral, Simultaneous, Acute Angle Closure Glaucoma in Pseudophakia Induced by Chlorthalidone.

Purpose. To report two persons with acute, bilateral, and simultaneous angle closure glaucoma in pseudophakia secondary to uveal effusions induced by administration of chlorthalidone. Methods. Case reports. Results. Bilateral shallow anterior chambers and high intraocular pressure with decline in visual acuity were reported in two patients within days of intake of chlorthalidone for systemic hypertension. Gonioscopy confirmed appositional angle closure while choroidal detachment and ciliochoroidal detachment were revealed on ultrasonographic studies. Discontinuing chlorthalidone and institution of aqueous suppressants to reduce IOP and cycloplegics reversed angle closure and glaucoma. Conclusions. Reports of angle closure glaucoma in pseudophakic eyes induced by idiosyncratic reaction to chlorthalidone confirms that osmotic changes in the crystalline lens has no role in the pathogenesis of drug induced glaucoma and reaffirms that glaucoma is secondary to ciliochoroidal detachment and ciliary body rotation and edema.

Management of bilateral microspherophakia with secondary angle closure glaucoma

Microspherophakia is characterized by lenticular myopia, late development of lens dislocation, shallow anterior chamber and angle-closure glaucoma. If it is associated with angle closure glaucoma, the management can be challenging. To report the management of a case of bilateral secondary angle closure glaucoma with isolated microspherophakia and right subluxated lens in a middle aged lady. A 47-year-old female presented with bilateral secondary angle closure glaucoma with isolated microspherophakia, right subluxated lens and left operated trabeculectomy. The patient`s best corrected log mar visual acuity improved from 1.0 to 0.2 and intraocular pressure (IOP) decreased from 24.9mm of Hg to lower teens following lensectomy with scleral fixation of posterior chamber intraocular lens in the right eye. The left eye IOP remained in mid teens without medication in two year follow up. This case demonstrates that microspherophakia should be ruled out even in middle aged patients presenting as angle closure glaucoma. The possibility of thickened cornea must be kept in mind requiring an IOP correction. Lensectomy with scleral fixation of posterior chamber IOL provides a satisfactory recovery of visual acuity and IOP control. Though in this patient, the lens was held in position by posterior synechiae in the left eye, future stability of zonules needs to be monitored.

Bilateral Simultaneous Angle-closure Glaucoma Associated With Septic Condition of Korean Hemorrhagic Fever (KHF)

To report a case of bilateral simultaneous angle-closure glaucoma caused by septic condition of Korean hemorrhagic fever. A 62-year-old man visited our emergency center with signs of sepsis (fever, leukocytosis, and oliguria). After 4 days of hospitalization, the patient reported blurred vision. Upon ophthalmologic examination, elevated intraocular pressure, edematous cornea, closed anterior chamber angle, and shallow anterior chamber without iris bowing were found in both eyes in slit-lamp examination and in Pentacam (Oculus, Wetzlar, Germany) Scheimpflug images. Bilateral choroidal effusion was observed on an ultrasound B scan as well. The serologic test for anti-hantaan virus immunoglobulin G (IgG) was positive. Along with the sepsis treatment, intravenous hyperosmotic agent, antiglaucoma eye drops, and 1% atropine eye drop were administered immediately. To control the choroidal effusion, systemic steroid was also administered. After 4 months, anterior chamber depth and choroidal effusion were normalized. Systemic causes should be considered in patients with bilateral angle-closure glaucoma, and Korean hemorrhagic fever can be one of the causes in endemic areas.