topiramate and Glaucoma--Angle-Closure

Topiramate-induced acute angle closure (TiAAC) is a potentially vision-threatening side effect of topiramate (TPM) use. The purpose of this article is to review demographic characteristics, clinical features, and management options of TiAAC. A systematic literature search of all reported cases and case series of TiAAC was conducted in the following search engines: PubMed, Web of Science, Google Scholar, Elsevier, and EBSCO. Seventy-three publications describing 77 cases were included. 58 (75.3%) patients were female, and the mean age was 34.88 ± 11.21 years (range, 7-57). The most commonly reported indication of TPM use was migraine headache (59.7%), and the mean duration from starting treatment until the onset of angle closure was 14.1 ± 31.5 days. All cases were managed by immediate cessation of TPM and topical therapy. In addition, systemic medications (carbonic anhydrase inhibitors, hyperosmotic agents, and steroids) were used in 51 patients (66.2%). A laser and/or surgical intervention was performed in 10 patients (13%). After commencement of treatment, the mean duration until the resolution of TiAAC was 3.9 ± 3.6 days (range, 1-18). The findings of our study present a summary of the current body of evidence provided by case reports and case series on TiAAC. In conclusion, the onset of angle closure following TPM use peaks at 2 weeks after initiating treatment, and in most cases, successful management can be achieved by discontinuing TPM and initiating appropriate medical therapy.

Topics: Acute Disease; Adult; Anticonvulsants; Female; Fructose; Glaucoma, Angle-Closure; Humans; Male; Middle Aged; Migraine Disorders; Topiramate; Young Adult

Topiramate (TPM) is a drug commonly used by neurophysicians and psychiatrists for a plethora of indications. Topiramate has been reported to induce acute angle closure glaucoma as an adverse effect. However, there is limited literature on Topiramate causing hypopyon uveitis and intense ocular inflammation. It is imperative for ophthalmologists as well as physicians to be aware of the potential sight threatening ocular adverse effects of Topiramate. We report 2 rare consecutive cases of severe hypopyon uveitis and choroidal detachments after using Topiramate.. Two patients presented with sudden onset of angle closure, bilateral hypopyon uveitis and choroidal detachments. On reassessing a detailed treatment history, it was found that both patient were taking oral Topiramate which had been started 2 weeks before the onset of ocular symptoms. The bilateral hypopyon and angle closure were considered to be induced by Topiramate and the drug was discontinued. The patients were started on oral and topical steroids which led to resolution of hypopyon uveitis and choroidal detachments. The visual acuity improved and the intraocular pressure also got normalised in both the cases.. Topiramate can lead to a bilateral hypopyon uveitis and severe ocular inflammation. An urgent cessation of topiramate along with topical and systemic steroids is required to prevent serious complications.

Topics: Choroidal Effusions; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Topiramate; Uveitis

To report two cases of ciliochoroidal effusion after the usage of topiramate.. Two middle-aged women experienced sudden onset of acute glaucoma and acquired myopia after taking topiramate. Ultrasound biomicroscopy demonstrated bilateral ciliochoroidal effusion and angle closure. The A-scan ultrasonography revealed shallow anterior chamber and thick lens. After the treatment and drug withdrawal, intraocular pressure, refractive status and angle anatomy returned to normal and there was resolution of ciliochoroidal effusion. During the clinical course, the anterior chamber depth (ACD) increased from 2.02 to 3.30 mm (1.28 mm of changes) OD and from 1.94 to 3.36 mm (1.42 mm of changes) OS. The lens thickness (LT) became thinner from 4.53 to 4.31 mm (0.22 mm of changes) OD and from 4.59 to 4.30 mm (0.29 mm of changes) OS in the first case. In the second case, the ACD increased from 2.33 to 3.07 mm (0.74 mm of changes) OD and from 2.30 to 3.05 mm (0.75 mm of changes) OS. The LT became thinner from 4.42 to 4.27 mm (0.15 mm of changes) OD and from 4.38 to 4.26 mm (0.12 mm of changes) OS. The forward displacement of the lens-iris diaphragm contributed more to the shallowness of the anterior chamber than the thickening of the lens itself (only accounting for 20%).. Topiramate-induced bilateral acute angle closure glaucoma and myopic shift was due to ciliochoroidal effusion which resulted in thicker lens and shallow anterior chamber. The later was mainly due to anterior displacement of the lens-iris diaphragm.

Topics: Anticonvulsants; Choroid Diseases; Female; Glaucoma, Angle-Closure; Humans; Hypoglycemic Agents; Middle Aged; Myopia; Topiramate

A case is reported of acute bilateral myopia and angle closure glaucoma in a 7-year-old patient from topiramate toxicity. This is the second known reported case of topiramate induced acute angle closure glaucoma and third known reported case of topiramate induced acute myopia in a pediatric patient.. This case presents a 7-year-old who had recently begun topiramate therapy for seizures and headache. She developed painless blurred vision and acute bilateral myopia, which progressed to acute bilateral angle closure glaucoma. After a routine eye exam where myopia was diagnosed, the patient presented to the emergency room with symptoms of acute onset blurry vision, tearing, red eyes, swollen eyelids, and photophobia. The symptoms, myopia, and angle closure resolved with topical and oral intraocular pressure lowering medications, topical cyclopentolate, and discontinuation of topiramate.. Acute angle closure glaucoma is a well-known side effect of topiramate, but is rarely seen in children. It cautions providers to the potential ophthalmic side effects of commonly used medications in the pediatric population. It highlights the need to keep a broad differential in mind when encountering sudden onset blurry vision in the primary care clinic, the need for careful consideration of side effects when starting topiramate therapy in a child, and the need for parental counseling of side effects.

Topics: Anticonvulsants; Child; Diagnosis, Differential; Female; Fructose; Glaucoma, Angle-Closure; Headache; Humans; Myopia; Seizures; Topiramate

Secondary angle-closure glaucoma with pupillary block can be related with anticholinergic drugs or sympathicomimetics alpha1. Secondary angle-closure glaucoma with ciliary body oedema is predominantly related with Topiramate.

Topics: Acute Disease; Cholinergic Antagonists; Ciliary Body; Edema; Fructose; Glaucoma; Glaucoma, Angle-Closure; Humans; Sympathomimetics; Topiramate; Uveitis

Topics: Adolescent; Adult; Aged; Anticonvulsants; Anxiety Disorders; Female; Fructose; Glaucoma, Angle-Closure; Humans; Male; Middle Aged; Migraine Disorders; Myopia; Pain; Personality Disorders; Topiramate; Weight Loss

Topics: Anticonvulsants; Fructose; Glaucoma, Angle-Closure; Humans; Topiramate

Topamax (topiramate) is a drug used in the treatment of epilepsy or migraine. Its use may rarely be associated with the occurrence of secondary angle-closure glaucoma due to supraciliary effusion. Although the ocular finding resembles primary angle-closure glaucoma, bilateral infliction should always raise the suspicion that it is drug-induced glaucoma.. The authors present a case of a 51-year-old patient on Topamax therapy with sudden vertigo, headache and blurred vision. Ophthalmic examination revealed bilateral angle-closure glaucoma, which was initially treated in the classical manner by administration of local antiglaucoma drugs and pilocarpine, followed by administration of osmotically active substances and laser iridotomy. Only the subsequent discontinuation of Topamax and the use of local cycloplegics and corticosteroids led to the release of the anterior segment angle closure and normalization of intraocular pressure.. The indicating physician and ophthalmologist must be aware of the possible side effects of Topamax therapy to determine the correct diagnosis and to administer treatment appropriately.

Topics: Fructose; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Middle Aged; Tonometry, Ocular; Topiramate

Topics: Exudates and Transudates; Glaucoma, Angle-Closure; Humans; Iatrogenic Disease; Topiramate; Uveal Diseases

Sulphamate drugs, widely prescribed for various systemic conditions, are reported to have rare ocular adverse-effects, usually within weeks of initiation of treatment. Medical and drug history in such cases are of pivotal importance in reaching a proper diagnosis. This study reports three cases, which developed topiramate-induced ocular side effects. In one of the cases, although the angles were narrow in both eyes, yet intra-ocular pressure (IOP) was not high. Also, in the third case, there were no macular striae. Topiramate was immediately withheld and all cases were improved without any permanent ocular damage. Key Words: Sulphamate, Topiramate, Angle closure glaucoma, Myopia.

Topics: Anticonvulsants; Fructose; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Myopia; Topiramate

Topiramate is a drug commonly used by physicians. However, it has various systemic and ocular adverse effects. Bilateral angle closure crisis is a potentially blinding adverse reaction that is seldom reported in non-ophthalmic journals.. This article aims to report a case series of topiramate-induced angle closure crisis in the eyes.. Most patients presented to us with blurred vision and high intra-ocular pressure within days of starting topiramate tablet for headache. However, the attack resolved in those who presented early with prompt treatment, which included stopping topiramate.. Physicians prescribing topiramate must be well aware of this potentially blinding adverse effect. Educating the patient about this possible side effect is important. Timely referral and treatment can prevent blindness in these individuals.

Topics: Adult; Analgesics; Female; Glaucoma, Angle-Closure; Headache; Humans; Middle Aged; Topiramate

Topics: Adult; Anterior Eye Segment; Choroidal Effusions; Female; Glaucoma, Angle-Closure; Humans; Hypoglycemic Agents; Intraocular Pressure; Microscopy, Acoustic; Tomography, Optical Coherence; Topiramate

To report a patient with fluctuating refraction following the use of oral topiramate.. A 38-year-old male patient was diagnosed elsewhere with sudden-onset-acquired myopia, high intraocular pressure, and bilateral angle closure glaucoma for which he underwent laser peripheral iridotomy in both eyes and was started on topical antiglaucoma medications and topical steroids following laser peripheral iridotomy. He was referred for ultrasound biomicroscopy, which showed bilateral ciliary effusion. Ultrasound of eyes revealed choroidal thickening. On further questioning, he was noted to have taken oral topiramate for 7 days, which he stopped a week before the ocular symptoms. He was started on atropine, on which the acquired myopia resolved, the anterior chamber deepened, and the intraocular pressure came down. After 4 days, he developed acquired hyperopia in the left eye. Neurosensory retinal detachment at the posterior pole was documented with optical coherence tomography. The fluorescein angiography showed few ink-blot leaks and one smokestack leak in the left eye. The neurosensory detachment resolved spontaneously with an uncorrected visual acuity of 6/6 in either eye.. A unique case of central serous chorioretinopathy following oral intake of topiramate is presented. This patient had also received laser peripheral iridotomy and topical steroids following the peripheral iridotomy.

Topics: Adult; Atropine; Central Serous Chorioretinopathy; Fluorescein Angiography; Glaucoma, Angle-Closure; Humans; Hyperopia; Hypoglycemic Agents; Intraocular Pressure; Laser Therapy; Lasers, Solid-State; Male; Microscopy, Acoustic; Mydriatics; Myopia; Retinal Detachment; Tomography, Optical Coherence; Tonometry, Ocular; Topiramate; Visual Acuity

We report the case of a 29-year-old epileptic woman who had been on treatment with topiramate 25mg/day for 9 days. She was referred to the Emergency Department due to reduction in far visual acuity (VA) after increasing the dose to 50mg/day two days before. The ocular examination showed bilateral acute angle closure glaucoma (AACG) and macular striae in both eyes (AO) observed by Retinography and Optical Coherence Tomography (OCT). The AACG is a well-known side effect of topiramate, but the macular striae rarely accompanies it. Although macular striae have been previously described in other cases, very few document those using retinography and OCT images. Therefore, it is important to differentiate a case of AACG induced by topiramate from a case of primary AACG, since they differ in their clinical presentation, mechanism of action, and treatment. Mismanagement can have potentially serious consequences.

Topics: Acute Disease; Adult; Anticonvulsants; Female; Glaucoma, Angle-Closure; Humans; Macula Lutea; Myopia; Retinal Diseases; Topiramate

A 45 year-old man with bilateral acute angle-closure and myopia after starting treatment with topiramate, secondary to alcohol and heroin dependence. Using Visante® OCT (Optical Coherence Tomography) and B-scan Ultrasound he was diagnosed with bilateral ciliochoroidal effusion as the pathophysiological mechanism. Topiramate was stopped and ocular hypotensive therapy with a topical cycloplegic and corticosteroids were started, resolving ciliochoroidal effusion syndrome. Visante® OCT and B-scan Ultrasound are useful tools for the diagnosis and follow-up of patients with acute angle-closure and myopia due to topiramate. As a result of broad spectrum of indications for topiramate, physicians and ophthalmologists should be aware of the possible ophthalmological manifestations attributable to this drug.

Topics: Adrenal Cortex Hormones; Alcoholism; Anticonvulsants; Choroidal Effusions; Follow-Up Studies; Glaucoma, Angle-Closure; Heroin Dependence; Humans; Male; Microscopy, Acoustic; Middle Aged; Mydriatics; Myopia; Tomography, Optical Coherence; Topiramate

Topics: Adult; Anticonvulsants; Female; Glaucoma, Angle-Closure; Glucocorticoids; Gonioscopy; Humans; Infusions, Intravenous; Intraocular Pressure; Male; Methylprednisolone; Middle Aged; Topiramate; Trabecular Meshwork

A 36-year-old female presented with the complaints of pain, photophobia, redness, and sudden diminution of vision in both the eyes following topiramate for migraine treatment. On examination, there was panuveitis with angle-closure glaucoma in both the eyes with fibrinous exudate with pigments in the anterior chamber of the left eye. B scan revealed increased choroidal thickness in both the eyes. Serial anterior segment optical coherence tomography scans were done in the left eye to demonstrate the gradual resolution of the fibrin material from the anterior chamber. There was complete resolution of inflammation in both eyes following discontinuation of topiramate and treatment with systemic and topical steroids. There was an improvement in visual acuity in the left eye following complicated cataract surgery.

Topics: Administration, Oral; Adult; Anterior Eye Segment; Anti-Obesity Agents; Female; Fructose; Glaucoma, Angle-Closure; Gonioscopy; Humans; Intraocular Pressure; Microscopy, Acoustic; Panuveitis; Severity of Illness Index; Tomography, Optical Coherence; Topiramate; Visual Acuity

Topics: Anticonvulsants; Glaucoma, Angle-Closure; Humans; Topiramate

A 46-year-old woman presented to the emergency department with progressive bilateral loss of vision followed by headache. She had been taking topiramate 25 mg daily for eight days before presentation. In the end, she was diagnosed with topiramate-induced acute glaucoma for which she received appropriate treatment.

Topics: Acute Disease; Blindness; Female; Fructose; Glaucoma, Angle-Closure; Headache; Humans; Middle Aged; Topiramate

Epidemiologic studies have shown that antidepressants may increase the risk of angle-closure glaucoma. We examined the risk of angle-closure glaucoma with bupropion hydrochloride, a unique, popular antidepressant also marketed as a smoking cessation aid.. A nested case-control study was conducted using a large health claims database in the United States from January 1, 2006, to March 31, 2014. The database contained deidentified information pertaining to a cohort of 6 110 723 patients. Cases were defined according to the first coding for angle-closure glaucoma. For each case, 10 control participants were selected and matched to the cases using density-based sampling. Adjusted rate ratios were computed for bupropion, topiramate (positive control group drug), and esomeprazole (negative control group drug). The adjusted rate ratio was 1.09 (95% CI, 0.75-1.59) for bupropion and 2.59 (95% CI, 1.56-4.30) for topiramate. In a prespecified analysis of patients younger than 50 years, the adjusted rate ratio was 1.98 (95% CI, 1.02-3.84) for bupropion and 5.30 (95% CI, 2.54-11.04) for topiramate.. Both bupropion and topiramate are widely prescribed drugs. The risk of angle-closure glaucoma in patients younger than 50 years was twice as high in patients taking bupropion and more than 5 times higher in patients taking topiramate.

Topics: Adolescent; Adult; Anticonvulsants; Antidepressive Agents, Second-Generation; Bupropion; Case-Control Studies; Databases, Factual; Esomeprazole; Female; Fructose; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Male; Middle Aged; Odds Ratio; Proton Pump Inhibitors; Retrospective Studies; Risk Factors; Tonometry, Ocular; Topiramate; Young Adult

Topiramate is a recognized cause of drug-induced acute angle-closure glaucoma. We describe a case presenting with bilateral acute angle-closure glaucoma caused by topiramate intake. Patient subsequently developed severe anterior uveitis caused by sulphonamide derivatives (acetazolamide and co-trimoxazole) due to cross-sensitivity, on two separate occasions. The present case also highlights the role of anterior segment optical tomography in diagnosis and follow-up. In a patient with known drug allergy to topiramate, other sulphonamide derivatives should be avoided to limit the ocular morbidity.

Topics: Adult; Female; Fructose; Glaucoma, Angle-Closure; Humans; Neuroprotective Agents; Sulfonamides; Topiramate; Uveitis, Anterior

Topics: Acute Disease; Adult; Anticonvulsants; Antihypertensive Agents; Choroid Diseases; Ciliary Body; Drug Therapy, Combination; Female; Fructose; Glaucoma, Angle-Closure; Glucocorticoids; Humans; Intraocular Pressure; Microscopy, Acoustic; Mydriatics; Tonometry, Ocular; Topiramate; Uveal Diseases

A 54-year-old male patient presented to our clinic with acute angle-closure glaucoma and panuveitis in both eyes after being treated with topiramate for binge eating and obesity. This case report emphasises the hazardous side effects of treatment with topiramate with unusual indication and the precaution a caretaker must take when treating a patient.

Topics: Acute Disease; Anti-Obesity Agents; Fructose; Glaucoma, Angle-Closure; Humans; Male; Middle Aged; Panuveitis; Topiramate

Topics: Acute Disease; Adult; Anti-Inflammatory Agents; Anticonvulsants; Antihypertensive Agents; Female; Fructose; Glaucoma, Angle-Closure; Humans; Migraine Disorders; Neuroprotective Agents; Topiramate; Treatment Outcome; Uveitis, Anterior

We present a case report of a 31-year-old female patient who presented to us with a 1 day history of acute bilateral eye pain, blurred vision and headache. She was found to have a myopic shift, raised intraocular pressure (IOP) and shallow anterior chambers in both eyes. She had been commenced on oral topiramate 1 week previously. A number of investigations, including anterior segment optical coherence tomography (AS-OCT) were done and a diagnosis of topiramate induced bilateral acute angle closure (TiAAC) was made. Topiramate was discontinued and she was managed with topical and oral antiglaucoma medications, topical steroids and cyclopegics. Her symptoms subsided dramatically at the next follow-up. The AS-OCT documentation revealed lucidly the improvement in her anterior chamber depth and anterior chamber angle parameters. Her IOP decreased, her myopic shift showed reversal and her AS-OCT findings revealed gross improvement in all the parameters angle opening distance, trabecular iris space area and scleral spur angle. This case report clearly shows with AS OCT documentation the changes which occur in the anterior segment in a case of TiAAC.

Topics: Acute Disease; Adult; Anterior Eye Segment; Documentation; Female; Fructose; Glaucoma, Angle-Closure; Gonioscopy; Humans; Intraocular Pressure; Neuroprotective Agents; Tomography, Optical Coherence; Topiramate

Topics: Acute Disease; Adult; Female; Fructose; Glaucoma, Angle-Closure; Gonioscopy; Humans; Intraocular Pressure; Migraine Disorders; Neuroprotective Agents; Tonometry, Ocular; Topiramate; Visual Acuity; Withholding Treatment

Topics: Adult; Anticonvulsants; Female; Fructose; Glaucoma, Angle-Closure; Humans; Topiramate

The case of a 20 year old female presenting with overnight acute loss of vision is reported. The patient was recently started on topiramate (Hitop) for her recurrent migraine and developed sudden loss of vision due to acute myopia. Topiramate was discontinued and the patient's vision returned to normal. Delayed and incorrect treatment may result in permanent vision loss, secondary to angle closure glaucoma; therefore it is imperative that prescribing physicians are aware of this rare but serious ocular emergency.

Topics: Edema; Female; Fructose; Glaucoma, Angle-Closure; Humans; Myopia; Neuroprotective Agents; Topiramate; Young Adult

Patients with migraine headaches are frequently prescribed topiramate to treat their condition.. We present a case of bilateral acute angle-closure glaucoma occurring 2 days after topiramate therapy was increased for symptoms related to migraine.. Acute angle-closure glaucoma secondary to topiramate is an uncommon but serious adverse reaction that may result in severe morbidity such as permanent visual loss if not recognized in a timely manner. Treatment differs from primary acute angle-closure glaucoma in that discontinuation of topiramate is necessary for the glaucoma to resolve.

Topics: Acute Disease; Anticonvulsants; Female; Fructose; Glaucoma, Angle-Closure; Humans; Middle Aged; Migraine Disorders; Topiramate

We describe the case of a 47-year-old woman who came to the emergency department (ED) complaining of worse than typical migraine headache and blurry vision after recently doubling the dose of topiramate earlier that day. After complete neurologic and ophthalmologic evaluation, she was found to have elevated intraocular pressures and was diagnosed with topiramate-induced bilateral acute angleclosure glaucoma, which is a rare side effect of this commonly prescribed medication. She was treated with timolol, brimonide, and prednisolone drops to reduce intraocular pressure as well as cessation of topiramate and was discharged home. This report briefly discusses the clinical history, appropriate evaluation, differential diagnosis, and approach to secondary acute angle-closure glaucoma in the ED.

Topics: Emergency Service, Hospital; Female; Fructose; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Middle Aged; Migraine Disorders; Neuroprotective Agents; Topiramate

Topics: Anticonvulsants; Female; Fructose; Glaucoma, Angle-Closure; Humans; Middle Aged; Migraine Disorders; Myopia; Topiramate

The aim of this article is to create awareness among medical colleagues regarding the severe ophthalmic side effects associated with topiramate use.. A case of severe acute bilateral angle closure glaucoma with visual blurring after oral topiramate therapy.. This case was successfully managed by discontinuing topiramate and by starting anti-glaucoma medication. Intraocular pressure, acute transient myopia, and anterior chamber depth were normalized.. It is important for clinicians to recognize these conditions and educate patients about these serious adverse effects when prescribing topiramate.

Topics: Adult; Female; Fructose; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Migraine Disorders; Topiramate; Treatment Outcome; Visual Acuity

To examine the possible link of acute-onset glaucoma with topiramate.. Case-control study.. A case-control study was conducted among a cohort of subjects who had visited an ophthalmologist in the Province of British Columbia, Canada from 2000 to 2007. Cases were identified as those newly diagnosed with glaucoma (ICD-9 360). For each case, 5 controls were selected and matched to the cases by age and calendar time using density-based sampling. Crude and adjusted rate ratios (RRs) for current and past use of topiramate were computed. As a sensitivity analysis, the risk of glaucoma with a positive control drug (an oral steroid) and a negative control drug (inhaled albuterol) was also assessed.. From the initial cohort of 989 591 subjects, 178 264 cases of glaucoma and 891 320 controls were identified. There was a slight increase in the risk of glaucoma among current users of topiramate (RR = 1.23 [95% confidence interval (CI), 1.09-1.40]). This risk was further elevated among new users of the drug (RR = 1.54 [95% CI, 1.09-2.17]). No increase in the risk of glaucoma requiring drug therapy was observed among current topiramate users (RR = 1.09 [95% CI, 0.80-1.61]).. We found an increase in the risk of glaucoma with first-time users of topiramate. Future studies are needed to confirm these findings.

Topics: Acute Disease; Aged; Anticonvulsants; British Columbia; Case-Control Studies; Databases, Factual; Epilepsy; Female; Fructose; Glaucoma, Angle-Closure; Humans; Incidence; Intraocular Pressure; Male; Risk Factors; Topiramate

We describe a 42 year-old patient who developed acute myopia and closed-angle glaucoma one week after beginning treatment with topiramate. Ultrasound biomicroscopy revealed a bilateral angle closure and choroidal effusion. The clinical findings resolved with withdrawal of the topiramate.. Topiramate may cause acute myopia and closure angle glaucoma in some patients due to a choroidal effusion. Ultrasound biomicroscopy seems to be a useful tool for monitoring the progression of the clinical lesions and their resolution when the drug is withdrawn.

Topics: Adult; Anti-Obesity Agents; Antidepressive Agents; Female; Fructose; Glaucoma, Angle-Closure; Humans; Microscopy, Acoustic; Myopia; Topiramate

We report two uncommon cases of acute onset myopia with macular folds following use of topiramate. A 25-year-old woman, with no prior history of glasses, taking topiramate for recurrent headaches, presented with decreased vision. On examination, she was found to have a refractive error of -5.00 DS in both eyes and intraocular pressure of 10 mmHg and 6 mmHg in the right and left eyes, respectively. She had closed angles on gonioscopy, ciliary effusion on ultrasonic biomicroscopy with inner limiting membrane folds in the macula in both eyes. She was on anti-glaucoma medication when she presented to us. A 20-year-old woman presented with acute headache and decreased vision following use of topiramate for treatment of migraine. On examination, her intraocular pressure was 25 mmHg in both eyes with closed angles on gonioscopy, a refractive error of -4.50 DS and prominent macular folds with no fluid in both eyes. There was complete resolution of macular folds and angle-closure attack after discontinuation of topiramate and conservative treatment with topical steroids and cycloplegics in both eyes. Topiramate toxicity may present with macular folds associated with angle-closure glaucoma. Folds in the inner limiting membrane might give a clue to choroidal effusion as the cause for this presentation. The symptoms resolved on the discontinuation of topiramate.

Topics: Adolescent; Adult; Female; Fructose; Glaucoma, Angle-Closure; Headache; Humans; Macula Lutea; Myopia; Neuroprotective Agents; Topiramate

Topiramate, a sulpha-based medication used in the treatment of migraine, has been documented as causing choroidal effusions, transient myopia and acute secondary angle closure glaucoma. We would like to report a case demonstrating these adverse effects and underscore the utility of ultrasound biomicroscopy in diagnosis and management.

Topics: Administration, Oral; Administration, Topical; Adult; Anticonvulsants; Female; Fructose; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Microscopy, Acoustic; Migraine Disorders; Prednisolone; Topiramate; Vision Disorders

A 38-year-old woman with a 10-year history of migraine without aura was treated with topiramate (TPM) for increasing frequency of headache. Initially, TPM was prescribed at a dose of 25 mg per day for 7 days, and then the dose was increased to 50 mg per day. Three days later, the patient complained of blurry vision, redness, and pain in both eyes. On ophthalmological examination, the pupils were found to be mid-dilated, and her visual acuity with correction was 1.2 in both eyes. Slitlamp examination revealed conjunctival hyperemia, chemosis, and shallow anterior chambers. Intraocular pressure in the right eye was 35 mmHg, while that in the left eye was 36 mmHg. Gonioscopy showed angle closure in both eyes, and therefore, a diagnosis of bilateral angle-closure glaucoma was made. TPM was discontinued immediately, and antiglaucoma medications were started. Four days after the initiation of antiglaucoma treatment, conjunctival hyperemia and chemosis disappeared and intraocular pressure in the right and left eyes decreased to 8 mmHg and 7 mmHg, respectively. The treatment was discontinued on the 11th day. To the best of our knowledge, this is the first case of TPM-induced angle-closure glaucoma in Japan.

Topics: Adult; Anticonvulsants; Female; Fructose; Glaucoma, Angle-Closure; Humans; Migraine Disorders; Topiramate

Topiramate, a sulfamate-substituted monosaccharide classically used as an antiepileptic medication, has been widely used since its recent indication for migraine prophylaxis. We report the case of a 68-year-old woman who developed bilateral acute glaucoma following topiramate migraine prophylaxis.. A 68-year-old woman presented in the emergency department for ocular pain, redness, and bilateral reduced visual acuity associated with nausea and vomiting. Initial examination found a bilateral corneal edema with shallow anterior chambers and closed iridocorneal angles. Intraocular pressure was 40mmHg in the right eye and 45mmHg in the left eye. Ultrasound biomicroscopy diagnosed ciliochoroidal detachment and swollen ciliary processes with closed angles, which was also objectified using the Visante OCT. Topiramate treatment was interrupted and a local and general hypotonic treatment was started. After 4 days, examination showed deeper anterior chambers and normal intraocular pressures. Visante OCT and ocular echography follow-up examinations were normal, and Indoramin was prescribed for migraine prophylaxis with no relapse after 10 months.. Bilateral acute angle-closure glaucoma is a possible complication of topiramate. Physicians and patients starting this therapy should be aware of this underestimated risk.

Topics: Acute Disease; Aged; Anticonvulsants; Female; Fructose; Glaucoma, Angle-Closure; Humans; Tomography, Optical Coherence; Topiramate

Topics: Eye; Fructose; Glaucoma, Angle-Closure; Humans; Psychotropic Drugs; Topiramate; Vision, Ocular

Topiramate is used in the management of epilepsy and migraine. In the present paper we present a case of bilateral acute angle closure glaucoma associated with myopia following the use of topiramate. The patient was admitted to our ward. Complete ophthalmological examination was carried out along with ultrabiomicroscopy of the anterior segment and confocal microscopic study of the corneal endothelium. Patients on treatment with topiramate should be monitored during the first two weeks of therapy and the drug should be discontinued in case of visual disturbances or other ocular symptoms.

Topics: Acute Disease; Adult; Female; Fructose; Glaucoma, Angle-Closure; Humans; Myopia; Topiramate

Topics: Acute Disease; Adult; Anticonvulsants; Female; Fructose; Functional Laterality; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Iridectomy; Iris; Lasers, Gas; Middle Aged; Topiramate

Describe bilateral acute onset myopia and angle-closure glaucoma as ocular adverse effects of topiramate.. A 23 year-old woman developed bilateral severe blurred vision seven days after initiating therapy with topiramate. Her visual acuity was counting fingers in both eyes. Intraocular pressures were 33 mmHg and 32 mmHg in the right and left eyes, respectively, with conjunctival chemosis, corneal edema, shallow anterior chambers, and closed angles. Her refraction was -7.50 diopters in both eyes. The symptoms and clinical findings resolved completely upon discontinuation of topiramate and, administration of antiglaucoma drugs.. Topiramate use can result in acute bilateral angle-closure glaucoma and myopia, which are usually reversible upon cessation of the drug. Visual outcome is usually good and the episode resolves within a few weeks. Thus, it is important for clinicians to recognize these conditions and educate patients about these serious adverse effects when prescribing topiramate.

Topics: Acetazolamide; Acute Disease; Adult; Anticonvulsants; Antihypertensive Agents; Cryoprotective Agents; Female; Fructose; Glaucoma, Angle-Closure; Glycerol; Humans; Intraocular Pressure; Myopia; Risk Factors; Timolol; Topiramate

Topics: Alcoholism; Excitatory Amino Acid Antagonists; Fructose; GABA Modulators; Glaucoma, Angle-Closure; Humans; Topiramate

Topics: Adolescent; Anticonvulsants; Antihypertensive Agents; Drug Therapy, Combination; Female; Fructose; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Migraine Disorders; Papilledema; Pseudotumor Cerebri; Topiramate

Topiramate, an antiepileptic medication, has been widely used since its recent indication for migraine prophylaxis. We report a case of bilateral angle-closure glaucoma and acute myopia in a 44-year-old woman on oral topiramate therapy initiation for migraine prophylaxis. Intraocular pressure was 31 mmHg right and 32 mmHg left, myopia was 4 diopters. Topiramate was interrupted and general and local hypotensive treatment begun and rapidly stopped after improvement. Iridotomy was also performed. Fifteen days later, complete resolution was observed on ophthalmologic examination: anterior chambers were deep, myopia fully regressed, intraocular pressure returned to normal, and the visual field was complete. This new case prompts discussion on current reports in the literature and French drug monitoring database cases in this context.

Topics: Adult; Anticonvulsants; Female; Fructose; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Iridectomy; Migraine Disorders; Myopia; Topiramate; Treatment Outcome

Topics: Acute Disease; Adult; Anterior Eye Segment; Anticonvulsants; Cornea; Female; Fructose; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Iris; Tomography, Optical Coherence; Topiramate

Topics: Adult; Anticonvulsants; Female; Fructose; Glaucoma, Angle-Closure; Headache; Humans; Hydrocephalus; Topiramate; Ventriculoperitoneal Shunt; Vision Disorders

The purpose of this report is to describe acute myopia as an ocular adverse reaction to topiramate (Topamax, Ortho-McNeil, Raritan, NJ) and discuss the importance of recognizing this syndrome.. Retrospective case report and brief review of the literature.. A 27-year-old female patient developed decreased vision in both eyes due to acute myopia 2 weeks of after initiating therapy with topiramate. Emergency department evaluation revealed visual acuities of 20/400 right eye and 20/200 left eye. Intraocular pressures were 33 mm Hg right eye and 26 mm Hg left eye. The anterior chambers were shallow. Retinal striae were present in the maculae. The patient stated no previous need for optical correction. However, after initiating treatment with topiramate, she refracted to approximately -5.00 D bilaterally. Ultrasound testing revealed that the patient had suprachoroidal effusions in both eyes. The symptoms and clinical findings resolved completely with discontinuation of topiramate, administration of topical atropine 1% and prednisolone acetate 1%.. An acute myopic shift may be the presenting sign of an idiosyncratic drug reaction that can include secondary bilateral angle closure glaucoma. This condition can occur in patients who do not have a history of anterior chamber abnormalities. Recognizing this condition and discontinuing the use of the causative drug may prevent angle closure and associated vision loss.

Topics: Adult; Diagnosis, Differential; Female; Follow-Up Studies; Fructose; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Migraine Disorders; Myopia; Neuroprotective Agents; Ophthalmoscopy; Refraction, Ocular; Retrospective Studies; Severity of Illness Index; Tomography, Optical Coherence; Topiramate

To report the role of choroidal drainage in patient with acute bilateral angle closure secondary to cilio-choroidal effusion with Topiramate.. Interventional case report.. Two weeks after commencing tablet Topiramate (Sulfamate derivative) for management of epilepsy, a patient developed bilateral acute angle closure secondary to cilio-choroidal effusion with lenticulo-corneal touches for which choroidal drainage was performed in 1 eye.. After choroidal drainage, anterior chamber deepened, corneal edema resolved, choroidals started resolving, and intraocular pressure was controlled without medication.. In patients presenting with acute angle closure secondary to Topiramate toxicity, choroidal drainage if indicated, is a safe and effective interventional procedure.

Topics: Anticonvulsants; Choroid Diseases; Corneal Edema; Drainage; Epilepsy; Fructose; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Male; Microscopy, Acoustic; Middle Aged; Topiramate; Treatment Outcome; Ultrasonography

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.

Topics: Acute Disease; Anticonvulsants; Blood-Brain Barrier; Fructose; Glaucoma, Angle-Closure; Humans; Male; Middle Aged; Myopia; Topiramate

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.

Topics: Adult; Anterior Eye Segment; Diuretics, Osmotic; Drug Therapy, Combination; Female; Fructose; Glaucoma, Angle-Closure; Glucocorticoids; Humans; Intraocular Pressure; Mannitol; Methylprednisolone; Microscopy, Acoustic; Topiramate; Visual Acuity

We present an interventional case report of a rare occurrence of acute angle-closure glaucoma in a 35-year-old woman presenting 1 week after start of oral topiramate therapy for depression. Intraocular pressure measured 57 mm Hg OD and 56 mm Hg OS, and bilateral shallow anterior chamber and closed angles were observed. Ultrasound disclosed ciliochoroidal detachment, a closed angle with a forward shift of the lens, and swollen ciliary processes. Topiramate treatment was stopped. Antiglaucoma treatment was started and quickly tapered. After 5 days, examination showed deep anterior chambers and normal intraocular pressures with no medication.. Topiramate use can result in acute bilateral angle-closure glaucoma, which is usually reversible if the drug is discontinued. Patients starting topiramate therapy need to be informed of this potential risk.

Topics: Acute Disease; Adult; Anticonvulsants; Antihypertensive Agents; Choroid Diseases; Female; Fructose; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Microscopy, Acoustic; Topiramate

Acute transient myopia with shallowing of the anterior chamber is a rare idiosyncratic response to many systemic and topical medications, including sulfonamides. Several such cases have been reported in the past, but are less frequently reported in recent times. We report a case of acute progressive myopia and bilateral angle closure due to Topiramate--a drug used for epilepsy and migraine prophylaxis.

Topics: Adult; Anterior Chamber; Female; Follow-Up Studies; Fructose; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Migraine Disorders; Myopia; Neuroprotective Agents; Refraction, Ocular; Topiramate; Ultrasonography

Topics: Acute Disease; Administration, Oral; Anticonvulsants; Female; Fructose; Functional Laterality; Glaucoma, Angle-Closure; Humans; Middle Aged; Migraine Disorders; Topiramate

Interventional case report.. In an institutional practice setting, two women, aged 25 and 45, developed acute myopia after starting topiramate for epilepsy. One patient also developed bilateral angle closure glaucoma.. Topiramate was discontinued. Anterior chamber shallowing was noted in both patients at presentation. Ultrasonography showed ciliochoroidal effusion. Baseline measurements of anterior chamber depth and lens thickness were obtained.. Topiramate may be associated with ciliochoroidal effusion with forward displacement of the lens-iris diaphragm and anterior chamber shallowing, resulting in acute myopia and angle-closure glaucoma. Increased lens thickness contributes only minimally (9%-16%) to anterior chamber shallowing.

Topics: Acute Disease; Adult; Anterior Chamber; Anticonvulsants; Epilepsy; Female; Fructose; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Middle Aged; Myopia; Topiramate; Ultrasonography

To evaluate spontaneous reports of ocular side effects associated with topiramate use.. Retrospective case series.. One hundred fifteen case reports, primarily of a specific ocular syndrome (acute secondary angle-closure glaucoma), were collected from spontaneous reporting systems: the Drug Safety section of Ortho-McNeil Pharmaceuticals, Inc. (Raritan, NJ), the Food and Drug Administration (Rockville, MD), the World Health Organization (Uppsala, Sweden), the National Registry of Drug-Induced Side Effects (Casey Eye Institute, Oregon Health & Science University, Portland, Oregon), and the world literature.. The data were evaluated using the World Health Organization Causality Assessment Guide to the certainty of a suspected adverse drug reaction.. Eighty-six cases of acute-onset glaucoma (83 bilateral and 3 unilateral), 17 cases of acute bilateral myopia (up to 8.75 diopters), 9 cases of suprachoroidal effusions, 3 cases of periorbital edema, and 4 cases of scleritis were reported. In those cases for which management was reported, 38% had laser or surgical peripheral iridectomy (21 cases).. In the "certain" category of the World Health Organization classification system, the following are caused by topiramate therapy: abnormal vision, acute secondary angle-closure glaucoma, acute myopia, and suprachoroidal effusions. All findings are reversible if recognized early and if the drug is discontinued. The first presenting symptom of acute secondary angle-closure glaucoma in many patients was blurring of vision. Peripheral iridectomy is ineffective for this type of angle-closure glaucoma.

Topics: Acute Disease; Adolescent; Adult; Adverse Drug Reaction Reporting Systems; Aged; Anticonvulsants; Child; Child, Preschool; Fructose; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Iris; Laser Therapy; Middle Aged; Registries; Retrospective Studies; Topiramate

Topics: Adult; Anterior Chamber; Anticonvulsants; Ciliary Body; Female; Fructose; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Male; Topiramate; Ultrasonography; Uveal Diseases; Visual Acuity

Topics: Anticonvulsants; Child, Preschool; Choroid Diseases; Ciliary Body; Exudates and Transudates; Female; Fructose; Glaucoma, Angle-Closure; Humans; Pupil Disorders; Topiramate; Ultrasonography; Uveal Diseases

Topics: Adult; Anticonvulsants; Choroid; Ciliary Body; Female; Fructose; Glaucoma, Angle-Closure; Humans; Middle Aged; Myopia; Seizures; Topiramate; Ultrasonography; Uvea; Uveal Diseases

Topics: Anticonvulsants; Child; Fructose; Glaucoma, Angle-Closure; Humans; Topiramate; Vision Disorders

Topics: Acetazolamide; Acute Disease; Adult; Anticonvulsants; Epilepsies, Partial; Female; Fructose; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Latanoprost; Myopia; Prostaglandins F, Synthetic; Topiramate; Treatment Outcome

Topics: Adolescent; Adult; Adverse Drug Reaction Reporting Systems; Anticonvulsants; Child; Child, Preschool; Drug Labeling; Female; Fructose; Glaucoma, Angle-Closure; Humans; Male; Middle Aged; Topiramate; United States; United States Food and Drug Administration

We describe a case of bilateral acute angle closure glaucoma associated with oral topiramate therapy. A 64 year old woman developed bilateral acute angle closure glaucoma two weeks after beginning topiramate therapy for peripheral diabetic neuropathy. A topical and systemic anti-glaucomatous treatment were given and laser peripheral iridotomies were performed and, the intraocular pressure were stabilized. However, the anterior chambers remained very shallow and peripheral ciliochoroidal detachment was observed and confirmed echographically. Assuming that the mechanism of acute bilateral simultaneous angle closure glaucoma differs from the common pupillary block, and is related to external cause, the topiramate therapy was discontinued, and the patient was treated with cycloplegic agent and steroids. A gradual deepening of the anterior chamber and resolution of the choroidal edema were accompanied by improvement of visual acuity and corneal clarity. The presumed mechanism of drug related acute bilateral angle closure glaucoma is choroidal effusion and detachment associated with forward budging of the iris-lens diaphragm. This, in turn, causes a shallow anterior chamber and blockage of the ocular draining system.

Topics: Cornea; Diabetic Neuropathies; Female; Fructose; Functional Laterality; Glaucoma, Angle-Closure; Humans; Middle Aged; Mydriatics; Neuroprotective Agents; Steroids; Topiramate; Ultrasonography; Visual Acuity

Topics: Acute Disease; Anticonvulsants; Choroid; Ciliary Body; Fructose; Glaucoma, Angle-Closure; Humans; Myopia; Syndrome; Topiramate; Uveal Diseases

We describe a case of bilateral angle-closure glaucoma associated with oral topiramate therapy.. Interventional case report. Case report with echographic illustration.. A 51-year-old man developed bilateral acute angle-closure glaucoma 2 weeks after beginning topiramate therapy for bipolar affective disorder. Laser peripheral iridotomy was performed in the right eye without resolution of the acute attack. Echography revealed lens thickening and ciliochoroidal detachments in both eyes. Visual acuity, intraocular pressure, and anterior and posterior segment anatomy normalized 2 weeks after cessation of topiramate therapy.. Topiramate, a new sulfa-derivative antiepileptic medication, may cause idiosyncratic ciliochoroidal detachments and ciliary body edema leading to anterior displacement of the lens-iris diaphragm, lens thickening, and acute angle-closure glaucoma.

Topics: Acute Disease; Administration, Oral; Anticonvulsants; Bipolar Disorder; Choroid Diseases; Fructose; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Male; Middle Aged; Topiramate; Ultrasonography; Visual Acuity

Topics: Adult; Anterior Eye Segment; Anticonvulsants; Exudates and Transudates; Female; Fructose; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Middle Aged; Topiramate; Ultrasonography; Uveal Diseases

Topics: Acute Disease; Adult; Anticonvulsants; Ciliary Body; Dilatation, Pathologic; Female; Fructose; Glaucoma, Angle-Closure; Humans; Myopia; Topiramate; Ultrasonography; Uveal Diseases; Visual Acuity