Secondary Angle Research Articles

Optimization of the immunorecognition layer towards Brucella sp. on gold surface for SPR platform

A successful immunosensor is characterized by a proper antibody immobilization and orientation in order to enhance the antigen recognition. In this work, a thorough characterization of the antibody functionalized gold surface is performed to set up the best conditions to implement in an optical platform for the detection of Brucella sp. Two different strategies are evaluated, based on a random immobilization and on an oriented one: a direct antibody immobilization on carboxylic mixed polyethylene (PEG) self-assembled monolayer (SAM) or only carboxylic PEG SAM interface is compared to an oriented immobilization on a layer of protein G on the same PEG SAM interfaces. X-ray Photoelectron Spectroscopy (XPS), Time of Flight Secondary Ion Mass Spectrometry (ToF-SIMS) and contact angle (CA) are used to chemically characterize the gold functionalized surface and ToF-SIMS is also used to confirm the right antibody orientation. Optical characterization is applied to monitor the functionalization steps and fluorescence measurements are used to set up the proper experimental conditions and also to detect Brucella bacteria on the surface. Best results are obtained with a 10 ng/μl incubation solution of antibody immobilized, in an oriented way, on a mixed PEG SAM interface.

Toxic optic neuropathy and acute angle closure secondary to divalproex sodium – A rare case report

This study aims to report the side effects of oral divalproex sodium in a 55-year-old woman presented with a bilateral sudden painless decrease of vision and frontal headache and nausea, causing unique development of optic neuropathy and secondary acute angle closure (AAC). She gave a history of taking oral divalproex sodium for her migraine headache for 2 weeks. On examination, the patient was found to have secondary AAC, optic neuropathy with high intraocular pressure, and optic disc edema in both eyes (BE). The patient was treated with topical medications. The best-corrected distance visual acuity revealed an improvement of 20/30 from hand movement in BE within 2 weeks from the initial presentation. The ocular side effect, induced by divalproex sodium and possibly even after withdrawal from the drug, on time early detection of secondary AAC, and optic neuropathy will improve the management and give optimal results.

Characteristics of Energy Dissipation in T-Shaped Fractured Rocks under Different Loading Rates

T-shaped fractured rocks in the engineering rock mass with different inclination angles, quantities, and cross patterns will cause slope landslides, cavern collapse, roof fall, and other disasters under the action of external forces. Deformation evolution of the T-shaped fractured rock is also significant for monitoring the stability of rock engineering structures. In this paper, the compression test of T-shaped fracture specimens was carried out under different loading rates. By modulating both the fracture inclination angle and the loading rate, the attributes pertaining to energy dissipation in the T-shaped fractured specimen were scrupulously scrutinized and subsequently expounded upon. The difference in the energy characteristics between fractured rock and intact rock was investigated to understand the deformation evolution of T-shaped fractured rock samples. The results show that when the fracture angle is 45° and 90°, the elastic strain energy and dissipated energy decrease as the secondary fracture angle increases. At the peak point, as the secondary fracture angle increases from 0°, the total absorbed energy, elastic strain energy, and dissipated energy of the T-shaped fractured rock increase, the ratio Ue/U of elastic strain energy to total energy increases, and the ratio Ud/U of dissipated energy to total energy decreases. The increase in loading rate leads to an increase in Ue/U and a decrease in Ud/U at the peak point of the T-shaped fractured rock specimen. The increase in loading rate leads to an increase in the total absorbed energy and elastic energy at the peak point of the T-shaped fractured rock, while the dissipated energy decreases. Investigative endeavors into the mechanics and energetic attributes of T-shaped fractured rocks bestow pragmatic and directive significance upon the safety assessment and stability prognostication of sundry geological undertakings.

Primary Transscleral Diode Laser Cyclophotocoagulation for Management of Glaucoma in Nanophthalmic Eyes.

The aim of this study was to assess the efficacy and safety of double-row transscleral cyclophotocoagulation in controlling intraocular pressure in patients with secondary angle closure glaucoma due to nanophthalmos, not being controlled by medical therapy. A prospective case series study that included 13 eyes of 8 patients diagnosed with secondary angle closure glaucoma due to nanophthalmos at the Giza Eye Subspeciality Center, treated by 24 cyclodiode applications in a double-row technique. Success was defined as complete success by control of intraocular pressure <21mmHg without medication and qualified success in which control of pressure <21mmHg achieved with 1 or 2 medications. The average reduction in intraocular pressure at 3 months was 57.3±20.14% and at 6 months 44.5±32%, with an average eye drop intake of 1.3±0.8 drops. There was a significant reduction of intraocular pressure at 6 months compared with the preprocedure pressure ( P =0.01). Complete success achieved in 3 eyes, pressure controlled without any medication, and qualified success in 9 eyes. Transscleral cyclophotocoagulation is a safe and effective primary therapy for managing glaucoma in nanophthalmic eyes.

Difficulties of Cataract Surgery in Lens-Induced Glaucoma Due to Subluxated Cataract

Introduction: Cataract is a disease of the eye in which the normal clear lens has opacified and obscured the passage of light. A mature cataract occurs when the lens is opacified. Lens subluxation is a condition when the crystalline lens is not in its anatomical position that can result in decreased anterior chamber depth. It is a potentially high risk of developing pupillary block, leading to lens-induced glaucoma (secondary angle closure glaucoma). In this case, the definitive therapy is lens extraction, which is challenging for cataract surgeons. This case report aims to expose the difficulties of cataract surgery in lens-induced glaucoma due to subluxated cataract. Case Presentation: A 56-year-old male presented with unable to see in his right eye, followed by foggy vision, glare when seeing the light, and a history of an acute glaucoma attack. His right best corrected visual acuity (BCVA) was 1/300, and the intraocular pressure (IOP) was 5 mmHg on therapy with glaucoma medications. Slit lamp examination of the right eye showed a shallow anterior chamber, irradiated iris, mid-dilated pupil, completely cloudy lens, and a capsular instability around 12 to 6 clock hours (180°/2 quadrant). This patient was diagnosed with mature cataract and lens-induced glaucoma due to subluxated mature cataract and was given glaucoma medications also underwent phacoemulsification (PE) along with Intraocular lens (IOL) and capsular tension ring implantation due to the lens instability and excessive lens movement. Conclusions: Cataract surgery for subluxated mature cataract and lens-induced glaucoma is challenging because of the shallow anterior chamber, capsular instability, and excessive lens movement. A thorough diagnosis, preoperative evaluation, postoperative monitoring, and evaluation are essential for safe cataract surgery, reducing the risk of complications and achieving a good result.

Visual outcome of standard treatment of sarcoid uveitis at a tertiary eye center in Nepal

Introduction: Sarcoidosis is a less-studied disease in Nepal, both as a systemic as well as ocular disease. We aimed to describe the visual outcome of standard therapy of sarcoid uveitis in Nepal. Methods: Observational study through Electronic Medical recording system of Tilganga Institute of Ophthalmology from December 2017 to March 2020. Patients diagnosed by IWOS criteria, treated with standard protocol and with minimum six-month follow up were included. The clinical parameters evaluated were type of uveitis, anatomical location and IWOS category. Treatment related factors evaluated were need for immunosuppressants, anti-glaucoma medication and cataract surgery. Visual outcome at six months was the major outcome evaluated, considering two lines of improvement or worsening as significant. Vision limiting complications assessed were cystoid macular edema, complicated cataract and secondary glaucoma. Visual outcome was stratified based on demography, anatomical involvement, uveitis subtype, IWOS category and need for immunomodulators. Results: Forty-six eyes of 25 patients were included. Based on IWOS criteria, presumed ocular sarcoidosis had best visual outcome with 93.33% improvement. Males had better post-treatment vision (90% vs.76.9%). 20-40 years age group had best improvement (96.5%) and anterior uveitis had best visual outcome (100%). A single immunomodulator could not be recommended based on this study. 18(39%) eyes had raised IOP, 4(8.6%) had secondary angle closure glaucoma, 4(8.6%) had hypotony, 1(2.1%) eye underwent cataract surgery and 1(2.1%) eye had cystoid macular edema. Conclusions: Sarcoid uveitis has good visual outcome. High degree of suspicion, early diagnosis and prompt treatment aids in diagnosis and limits vision-limiting complications.

More to it than meets the eye- A case of Takayasu arteritis and antiphospholipid syndrome, associated with ocular ischemic syndrome, neovascularization and secondary angle closure

We describe an atypical case of bilateral ocular ischemic syndrome with neovascularization and secondary angle closure in a 28-year-old lady with features of antiphospholipid syndrome (APS) and Takayasu arteritis; the latter being detected on evaluation of the etiology of the ocular condition. She was treated with pan retinal photocoagulation in one eye and anterior retinal cryotherapy in the other eye (due to poor visualization of the retina initially) followed by cataract surgery. Systemic evaluation was done. Takayasu arteritis was detected and appropriate management was advised under specialist care. Her systemic condition was stable, ocular neovascularization was regressing, and visual acuity improved in the pseudophakic eye; a drop in visual acuity due to the progression of cataract and macular ischemia was noted in the phakic eye at follow-up. Timely detection and appropriate management of ocular and systemic conditions in such cases can preserve vision and limit further systemic morbidity.

Outcomes of XEN Stent in Patients With Glaucoma and Previous Corneal Transplantation.

The XEN stent safely and effectively controls intraocular pressure in select patients with history of corneal transplantation. Glaucoma is a common complication after corneal transplantation and can be difficult to manage in these patients. This study reports outcomes of XEN stent implantation in eyes with glaucoma in the setting of previous corneal transplantation. Noncomparative retrospective case series including eyes with a history of corneal transplantation and subsequent XEN stent implantation by a single glaucoma surgeon in Surrey, British Columbia, between 2017 and 2022. The analysis included patient demographics, pre and postoperative intraocular pressure (IOP), pre and postoperative glaucoma medications, peri and postoperative complications and interventions, and incidence of repeat corneal transplantation and additional glaucoma procedures to control IOP. Fourteen eyes with previous cornea transplantation underwent XEN stent implantation. Mean age was 70.1 years (range: 47-85y). Mean follow-up was 18.2 months (range: 1.5-52mo). The most common glaucoma diagnosis was secondary open angle glaucoma (50.0%). There was a significant reduction in IOP and the number of glaucoma agents at all postoperative time points ( P < 0.05). IOP decreased from 32.7 ± 10.0mm Hg at baseline to 12.5 ± 4.7mm Hg at the most recent follow-up. Glaucoma agents decreased from 4.0 ± 0.7 to 0.4 ± 1.0. Two eyes required additional glaucoma surgery to control IOP, with an average time to reoperation of 7 weeks. Two eyes underwent repeat corneal transplantation, with an average time to reoperation of 23.5 months. In selected patients with previous corneal transplants and refractory glaucoma, the XEN stent was safely implanted and effectively reduced IOP in the short term.

Social Vulnerability, Prevalence of Glaucoma, and Incidence of Glaucoma Surgery in the California Medicare Population

To examine associations of Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Social Vulnerability Index (SVI) scores with prevalence of glaucoma and incidence of glaucoma surgery in 2019 California Medicare beneficiaries. Retrospective cross-sectional study. 2019 California Medicare beneficiaries ≥ 65 years old with part A and part B coverage. The exposure of interest was SVI score, which was assessed overall and by themes. Outcomes included prevalence of glaucoma in the study population and incidence of glaucoma surgery in beneficiaries with glaucoma. Logistic regression modeling was performed to assess associations between quartiles of each type of SVI score, prevalence of glaucoma, and incidence of glaucoma surgery, controlling for age, sex, race/ethnicity, Charlson Comorbidity Index score, pseudophakia, and age-related macular degeneration. Prevalence of any glaucoma, primary open angle glaucoma (POAG), secondary open angle glaucoma (SOAG), and angle closure glaucoma in all beneficiaries. Incidence of any glaucoma surgery, trabeculectomy, tube shunt, minimally invasive glaucoma surgery (MIGS), and cyclophotocoagulation (CPC) in beneficiaries with glaucoma. Of 5 725 245 beneficiaries in the total study population, there were 215 814 (3.8%) with any glaucoma, and of those with glaucoma, 10 135/215 814 (4.7%) underwent glaucoma surgery. In adjusted analyses for overall SVI score, where higher levels of SVI refer to higher levels of social vulnerability, there were decreased odds of any glaucoma (adjusted odds ratio [aOR]=0.83; 95% confidence interval [CI]=0.82, 0.84 for Q4 vs. Q1), POAG (aOR=0.85; 95% CI=0.84, 0.87 for Q4 vs. Q1), and SOAG (aOR=0.59; 95% CI=0.55, 0.63 for Q4 vs. Q1) in higher (Q4) vs. lower (Q1) SVI quartile. There were increased odds of any glaucoma surgery (aOR=1.19; 95% CI=1.12, 1.26 for Q4 vs. Q1), MIGS (aOR=1.24; 95% CI=1.15, 1.33 for Q4 vs. Q1), and CPC (aOR=1.49; 95% CI=1.29, 1.76 for Q4 vs. Q1) for higher (Q4) vs. lower (Q1) SVI quartile. In the 2019 California Medicare population, there were variable associations between SVI score, prevalence of glaucoma, and incidence of glaucoma surgery. Further investigation is needed to understand the role of social, economic, and demographic factors in glaucoma care on the individual and structural levels. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Assessing Reuse of Hypodermic Needles in Mice by means of Digital Imaging, Photomicrography, Bacterial Culture, Analysis of Nest Building, and Animal Vocalization.

Hypodermic needles are sometimes reused in animal research settings to preserve the viability of and to conserve limited quantities of injected material. However, the reuse of needles is strongly discouraged in human medicine to prevent inju- ries and the spread of infectious disease. No official guidelines prohibit needle reuse in veterinary medicine, although the practice may be discouraged. We hypothesized that reused needles would be significantly more blunt than unused needles and that reuse for additional injections would cause more animal stress. To test these ideas, we evaluated mice that were injected subcutaneously in the flank or mammary fat pad to generate cell line xenograft and mouse allograft models. Needles were reused up to 20 times, based on an IACUC-approved protocol. A subset of reused needles was digitally imaged to determine needle dullness based on the area of deformation from the secondary bevel angle; this parameter was not different between new needles and needles that had been reused 20 times. In addition, the number of times a needle was reused was not significantly related to audible mouse vocalization during injection. Finally, nest building scores for mice that were injected with a needle used 0 through 5 times were similar to those of mice injected with a needle had been used 16 through 20 times. Among the 37 reused needles that were tested, 4 were positive for bacterial growth; the only organisms cultured were Staphylococcus spp. Contrary to our hypothesis, reusing needles for subcutaneous injections did not increase animal stress based on analysis of vocalization or nest building.

An Efficiency Optimization Method Based on Double Side Impedance Angle Design for Wireless Power Transfer System

Wireless power transfer (WPT) system has already been applied to battery charging occasions, and the charging process can be roughly divided into two stages: constant current mode (CCM) and constant voltage mode (CVM). In CVM, researchers always focus on the effect of the primary phase angle (PPA) on the system efficiency but rarely pay attention to secondary phase angle (SPA). A large SPA will also lead to a decrease of system efficiency, which should be worth more attention and consideration when designing the system parameter. The double-sided <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">LCC</i> compensation topology can not only achieve constant current or constant voltage output at different frequencies but also has the advantage of high parameter design freedom, so it is very suitable for battery charging scenarios. Considering the influence of the PPA and SPA on the system efficiency, a novel parameter design method based on double-sided <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">LCC</i> compensation topology is proposed in this article. By changing the system operating frequency, the switching between CCM and quasi-constant voltage mode (QCVM) is realized. In order to verify the feasibility and practical effect of the parameter design method, an experimental prototype based on a planar square coil was established and three groups of comparative experiments were conducted. The experimental results show that the optimized WPT system efficiency is significantly improved under the same power level. The maximum output power of the system is 620 W. When the optimized system works in CCM and QCVM, the maximum efficiency is about 95%.

Zonule-Associated Gene Variants in Isolated Ectopia Lentis and Glaucoma.

We report 3 novel variants in fibrillin-1 (FBN1) and latent transforming growth factor-β-binding protein 2 (LTBP2) in 3 families with isolated ectopia lentis (EL), which shed new light on the diagnosis and genetic counseling of EL and secondary glaucoma in clinical settings. To explore the genetic mechanism in 3 families with isolated EL and secondary angle closure glaucoma. Three Han Chinese families with EL and glaucoma were recruited. All of the participants underwent complete ocular and general physical examinations and DNA samples were extracted from peripheral venous blood and screened for disease-causing variants using whole exome and Sanger sequencing. In silico analyses were performed to predict the structural and functional changes in gene variants and abnormal proteins. All 3 probands presented with EL and pupillary-blocking glaucoma. Genetic testing showed that all the patients have zonule-related gene mutations, with the proband (II:1), as well as his mother (I:2) and daughters (III:1 and III:2) from family 1 carrying a heterozygous mutation in FBN1 gene (c.6493G>T:p.(V2165L)); the proband (II:1) from family 2 carrying a heterozygous mutation in FBN1 gene (c.2543C>A:p.(T848N)), and the proband (II:1) from family 3 carrying a pair of compound heterozygous mutations in LTBP2 gene (c.4825T>A:p.(C1609S) / c.529T>C:p.(W177R)). No other genetic variants were found to be associated with the phenotypes of patients and other family members in this study. All variants are predicted to affect the structure and function of proteins as risk factors for EL based on bioinformatics analysis. Four novel mutations were identified in 3 families with EL, suggesting an intimate link between specific mutations in FBN1 and LTBP2 and isolated EL and angle closure glaucoma. Our results expanded the variant spectrum of zonule-related genes and helped explore the underlying molecular pathology of these disorders.

Commentary: Reliability, repeatability, and accuracy of Sirius topographer in assessing anterior segment morphology following laser peripheral iridotomy in primary angle-closure disease.

Commentary: Reliability, repeatability, and accuracy of Sirius topographer in assessing anterior segment morphology following laser peripheral iridotomy in primary angle-closure disease.

Glaucoma de células fantasmas: Caso clínicio

Introduction: Ghost cell glaucoma (GCG) is a very rare secondary open angle glaucoma, in which there is a sustained increase in intraocular pressure (IOP) due to obstruction of the trabecular meshwork (TM) due to the passage of ghost cells (GC) from the vitreous into the anterior chamber, after a vitreous hemorrhage (VH). Clinical Case: We present the case of a male patient with a history of vitreous hemorrhage and sustained IOP elevation in the right eye (RE). Medical treatment was insufficient, for this reason surgical treatment was required. Postoperative evolution was favorable. Conclusion: This pathology should prefer the differential diagnosis of traumatic glaucomas, correlating high clinical suspicion and histological confirmation.

Bilateral crowning of lens equator with secondary angle closure glaucoma in a middle-aged female with microspherophakia

Bilateral crowning of lens equator with secondary angle closure glaucoma in a middle-aged female with microspherophakia

Malignant glaucoma: A therapeutic challenge

Malignant glaucoma is a rare condition characterized by an acute rise of intraocular pressure rise with a very shallow anterior chamber, generally following anterior segment surgery. The mechanism leading to malignant glaucoma is that in an anatomically predisposed eye, the anterior rotation of the ciliary body induces misdirection of aqueous flow into or behind the vitreous body, increasing vitreous volume, resulting in anterior displacement of the iris–lens diaphragm, axial and peripheral anterior chamber flattening, and secondary angle closure. The aim of this article is to report a case of malignant glaucoma to discuss about the risk factors involved and therapeutic approaches that are useful in managing such cases.

Iridocorneal Endothelial Syndrome – A Case Report

Iridocorneal endothelial (ICE) syndrome is a rare ophthalmic disorder, wherein the basic pathology is an abnormal corneal endothelium that leads to varying degrees of corneal oedema, iris atrophy, and secondary angle closure glaucoma.[1] This syndrome typically affects young women unilaterally with no family history.[2] The true aetiology of ICE syndrome is unclear. Viral cause for the disease has been proposed, based on a history of inflammation in certain cases and on the presence of inflammatory cells on histological analysis.[3] The abnormal endothelial cells may migrate posteriorly, forming a membrane that covers the adjacent structures, iris and trabecular meshwork.[4] The contraction of this membrane leads to characteristic iris changes, iridotrabecular synechiae, and corectopia with the pupil being drawn towards the area where the synechiae are most prevalent and to secondary angle-closure glaucoma.[5]

Time-dependent cracking and brittle creep in macrofractured sandstone

Time-dependent cracking and brittle creep of rock is fundamental to understanding the long-term evolution and dynamic failure in underground rock engineering. In the present paper, we present a systematic laboratory investigation into the control of single open macrofractures of differing orientations on time-dependent cracking and brittle creep in sandstone using digital image correlation (DIC). For a given macrofracture inclination angle β, we find that the failure of macrofractured sandstone under a constant stress is accompanied by the generation of more tensile fractures (wing cracks and secondary cracks) than in our constant strain rate experiments. This result differs from experiments performed on intact sandstones, for which macroscopic failure under a constant stress and constant strain rate were essentially identical. The nucleation site for the wing cracks is β-dependent. As β is increased, the crack nucleation position gradually moves from the center of the fracture towards the fracture tip with a decreasing speed. The kink angle of the secondary crack (k1) increases quasi-linearly with the increase of fracture angle γ. With the increase of the secondary crack angle θ, the kink angle of the tail crack (k2) shows different increasing trends for the left-lateral and right-lateral shear. The secondary crack could be inclined at a maximum of 26° (θ) to the maximum principal stress direction. Creep bursts—transient accelerations in deformation—are more easily triggered in macrofractured rock than in initially intact rock, and coincide in time with the coalescence of secondary cracks. The likelihood of occurrence of a creep burst was found to be higher for lower values of β. Finally, we present a secondary crack location map that defines the swing interval and identifies the fracture mechanism. The influence of a macrofracture, and its orientation, on damage evolution and the likelihood of creep bursts during interseismic periods provides crucial information for those tasked with monitoring hazards associated with the dynamic failure of crustal rocks.

Comparative analysis between early and late onset primary angle closure glaucoma

AbstractObjective: This prospective observational pilot study aimed at comparing the aetiology and clinical profile of early onset primary angle closure glaucoma (EPACG) with late onset primary angle closure glaucoma (LPACG).Methods: The early (18–40 year) and late (≥50 year) onset PACG patients without any surgical intervention or any other pathology (leading to secondary angle closure) were enrolled. One eye of each patient was considered for analysis. Clinico‐demographic details of the patients were noted. Anterior segment optical tomography (CASIA2, Tomey Corporation, Japan), Ultrasound biomicroscopy (Vumax, Sonomed, NY) were performed to identify the etiopathogenesis among two groups.Results: Mean age of participants was 32.8 ± 7.8 years EPACG (n = 45) and 55.83 ± 6.7 years in the LPACG group (n = 31). Relative pupillary block (90.32%, n = 28) was the commonest mechanism of angle closure in LPACG while non pupillary block [66.67%, n = 31, pseudoplateau iris‐ 44.44% (n = 20), plateau iris‐24.44% (n = 11)] was the commonest mechanism in EPACG group. The EPACG had significantly shorter axial length (22.1 ± 1.1 vs 22.93 ± 1; p = 0.003), thinner lens (4.35 ± 0.3 vs. 4.6 ± 0.2; p = 0.01), more anterior relative lens position (0.19 ± 0.01 vs. 0.2 ± 0.01; p = 0.007), lesser anterior chamber depth (2.1 ± 0.3 vs. 2.3 ± 0.32; p = 0.01) and lesser anterior chamber area (15 ± 3.3 vs. 16.7 ± 3.4; p = 0.04) compared to LPACG. EPACG had greater lens vault (0.79 ± 0.4 vs. 0.61 ± 0.2; p = 0.01) compared to LPACG. Among the EPACG, 15.55%, (n = 7, vs. none in LPACG) had nanophthalmos. The BCVA was worse in EPACG (0.2 (range 0–2) vs. 0.6 (0–2) logMAR in LPACG) despite refractive error being more emmetropic vs LPACG.Conclusions: Non pupillary block mechanisms are more common in EPACG as compared to LPACG. Despite thinner lens, early onset group has greater lens vault and shorter axial length contributing to greater angle crowding and present with greater visual morbidity.

Acute bilateral glaucoma related to uveal effusion syndrome associated with topiramate

AbstractPurpose: Drugs mostly sulfa‐related compounds, have produced uveal effusions, forward rotation of the iris‐lens diaphragm, transient myopia, and secondary angle closure. It has been recently encountered one case in which uveal effusions have occurred after administration of topiramate, a new anticonvulsant medication.Methods: A 54‐year‐old woman was seen in our emergency department with severe headaches, progressively blurry vision and photophobia in both eyes starting that morning. On examination, her visual acuity was hand movement in both eyes. Central corneal edema was observed, narrow chamber and anterior lens‐iris complex displacement with an unreactive middle pupil in both eyes. The funduscopic examination was difficult to assess due to the media opacity. Intraocular pressure measured with an applanation tonometer was 45 mm of mercury (mmHg) in the right eye and 50 mmHg in the left eye. Her medications included topiramate which she had started 2 weeks prior to initial examination due to headaches followed by neurology.Results: Topiramate‐induced angle closure has even been described as an idiosyncratic reaction in patients with normal depth of anterior chamber. The drug causes a prostaglandins increasement that trigger ciliary body edema at the local level but without acting at the systemic level. Ultrasound biomicroscopy shows the presence of a ciliochoroidal effusion syndrome, edema and the ciliary body anterolateral rotation, with zonular relaxation, changes that lead to iris‐lens diaphragm anterior displacement and, as a consequence, narrowing of the responsible anterior chamber with an acute glaucoma crisis.Conclusions: Topiramate is a sulfamate monosaccharide and belongs to a new generation of antiepileptic drugs, widely prescribed throughout the world as treatment of generalized tonic–clonic seizures and partial seizures. Prophylaxis of migraine, bipolar disorder, depression and neuropathic pain are other recent indications of its use. Bilateral acute glaucoma due to uveal effusion syndrome should be considered as an infrequent complication of topiramate use.References.1. Prithvi S. Sankar, MD; Louis R. Pasquale et al. Uveal Effusion and Secondary Angle‐Closure Glaucoma Associated With Topiramate Use. Arch Ophthalmol. 2001;119(8):1210–1211.