Topiramate-induced Angle Closure 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.

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.

Topiramate-induced angle closure glaucoma: Two unique case reports

Topiramate-induced angle closure glaucoma: Two unique case reports

Topiramate-induced angle closure glaucoma in a case of chronic migraine

Topiramate is an oral sulfamate medication used primarily for epilepsy and migraine. The tolerability profile with its lack of significant metabolic side effects makes it a favorable drug for patients with comorbid lifestyle illnesses. Topiramate-induced angle closure is an idiosyncratic reaction and can occur in otherwise normal eyes with normal anterior chamber angles. Ocular examination before starting topiramate cannot identify eyes at risk. Prompt cessation of therapy alone can result in rapid resolution of most of these adverse effects, whereas failure to recognize can lead to permanent visual problems. The internists should be aware of the documented side effects of topiramate, particularly when presented with simultaneous bilateral acute angle-closure glaucoma. Neurologists initiating therapy with topiramate should also educate the patients of its potential side effects and importance of reporting back immediately in case of any visual disturbance. Prompt cessation of topiramate is the mainstay of treatment. Supportive treatment in the form of oral and topical antiglaucoma drugs to reduce the intraocular pressure (IOP), topical steroids to bring down the inflammation, and topical cycloplegics to retract the ciliary processes thus bringing down the IOP has been recommended, but a few would warrant laser iridotomy or surgical iridectomy. We report a case of topiramate-induced angle closure glaucoma in a young female being managed as a case of chronic migraine, highlighting the importance of increasing the awareness of this rare, idiosyncratic adverse effect of topiramate and the need for timely intervention to avoid irreversible visual loss.

Bilateral acute myopia and angle-closure glaucoma in a migraine patient receiving Topiramate: a case report

We present a case of topiramate-induced angle-closure glaucoma that was treated with cycloplegia. A 40-year-old woman with a history of migraine presented with bilateral acute onset of blurred vision and headache. She had been prescribed 50 mg of oral topiramate bid for migraine prophylaxis 10 days prior to her presentation. On her ocular examination visual acuity was 20/20 with a myopic correction of -4.0 diopters in both eyes. Bio-microscopic examination revealed bilateral shallow peripheral anterior chambers. Intraocular pressures were 37 OD and 36 OS. On gonioscopic examination bilateral 360 degrees of angle closure was seen. B-scan ultrasonography showed peripheral choroidal effusions. The mainstay of the treatment for topiramate induced secondary angle closure is cyloplegia. Whenever a case of bilateral acute angle-closure glaucoma associated with myopia and shallow anterior chambers is encountered, ciliochoroidal effusion syndrome induced by drugs should be considered in the differential diagnosis.

Refractory topiramate-induced angle-closure glaucoma in a man: a case report

IntroductionTopiramate is a sulphonamide derivative indicated in the treatment of epilepsy and migraine. A known adverse affect is an idiosyncratic reaction that results in angle-closure glaucoma. We describe a patient with bilateral glaucoma related to topiramate that showed some unusual clinical features.Case presentationA 39-year-old Caucasian man presented with acute angle-closure glaucoma; he initially presented with intractable headaches after being treated with an escalating dose of topiramate. Clinical signs included elevated intraocular pressure that was initially refractory to treatment, shallow anterior chambers, and extensive bilateral choroidal effusions. After treatment with intravenous methylprednisolone, in conjunction with conventional glaucoma treatment, there was rapid reduction of intraocular pressure, gradual delayed resolution of the choroidal effusion and induced myopic shift; and eventually a good outcome without optic nerve damage.ConclusionThis case illustrates the importance of recognizing this entity in a non-ophthalmic setting and that intravenous methylprednisolone may be useful in the treatment of the condition when it is not responsive to conventional treatment. In addition, it is important to recognize that complete resolution of visual symptoms from the myopic shift may be delayed, despite normalization of intraocular pressure.

Glaucoma: Adverse event on use of topiramate in alcohol de-addiction

To report oral topiramate-induced glaucoma and to asses its severity and preventability. A 40-year-old manpresented with watering, redness, pain, and diminution of vision of both eyes, one week after initiation of oral topiramate 100 mg/day for alcohol de-addiction. On examination, both eyes showed conjunctival chemosis, corneal edema, shallow anterior chamber, and intraocular pressure 48 and 46 mm Hg. The symptoms and clinical findings resolved completely upon discontinuation of topiramate and administration of antiglaucoma drugs. Topiramate-induced angle-closure glaucoma and other ocular side effects are reversible if the diagnosis is made early and the drug is discontinued in time. Hence, clinician awareness is an important aspect of preventability of this adverse event.

Rapid Resolution of Topiramate-induced Angle-closure Glaucoma With Methylprednisolone and Mannitol

Topiramate-induced angle-closure glaucoma (TiACG) is believed to be related to its sulfonamide moiety. Although the exact mechanism is unknown, the time course and constellation of symptoms are consistent with a possible inflammatory pathophysiologic condition. Interventional case report. We report the clinical outcome of a case of TiACG that was associated with an extreme intraocular pressure elevation of >60 mm Hg that was treated with the combination of systemic mannitol and methylprednisolone. The combination of the two systemic medications resulted in the resolution of the attack with a much more rapid time course than is seen typically for extreme cases of TiACG. Mannitol treatment alone did not lower the intraocular pressure after 90 minutes, although improvement was noted four hours after methylprednisolone. For severe cases of TiACG that are associated with very high intraocular pressures, the combination of mannitol and methylprednisolone can induce a rapid improvement. Inflammation may be a component of TiACG.

Blood-Brain Barrier Disruption Associated with Topiramate-Induced Angle-Closure Glaucoma of Acute Onset

Topiramate (Topamax(R)) is an anti-epileptic drug of the sulfamate group used secondarily for bipolar disease. One week after initiation of topiramate treatment for a bipolar disorder, a 57-year-old man presented with blurred vision. Clinical examination revealed a bilateral conjunctivitis, areflexic mydriasis, severe anterior chamber shallowing, with a myopic shift and vitritis. A spinal tap revealed an increased protein content of 1581 mg/L on cerebrospinal fluid (CSF) analysis, being compatible with a rupture of the blood-brain barrier (BBB). UBM exposed bilateral ciliochoroidal effusions with secondary angle-closure. Topiramate was promptly discontinued, whereas visual acuity, intraocular pressure (IOP), and anterior and posterior segments anatomy normalized within 1 week. One month later, bilateral iris atrophy was present. The presence of BBB disruption with increased protein content in CSF with simultaneous blood ocular barrier breakdown may suggest a common inflammatory mechanism.