topiramate and Myopia

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

Topiramate, a new anticonvulsant, is also used for the prophylaxis of migraine and cluster headache. A serious but not often discussed side effect of the drug is the development of acute myopia and acute angle-closure glaucoma in the early stage of therapy that subsides rapidly with prompt discontinuation. One such case is reported here and the relevant literature in this regard is also reviewed.

Topics: Acute Disease; Adult; Anticonvulsants; Female; Fructose; Headache; Humans; Myopia; Topiramate

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

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

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: Acute Disease; Anticonvulsants; Diagnostic Imaging; Female; Fructose; Humans; Myopia; Refraction, Ocular; Topiramate; Young Adult

To investigate the accommodation function in topiramate users.. Case-control clinical study.. The participants included 16 controls and 22 patients using 100 mg/kg topiramate who were diagnosed with migraine according to the International Classification of Headache Disorders, second edition criteria.. One-minute dynamic measurements of refraction with accommodation stimuli of 0 D, 2 D, 2.5 D, 3 D, 4 D, and 5 D were obtained using the open field refractometer WAM-5500 in.. In most of the accommodation stimuli ranges (0 D, 2.5 D, 3 D, and 5 D), topiramate users had a significantly higher accommodative lag compared with controls (p = 0.028, p = 0.014, p = 0.011, and p = 0.011, respectively). The most important causes of accommodative lag were found to be accommodation stimulus and inclusion in the topiramate group (p < 0.001, R

Topics: Accommodation, Ocular; Adult; Anticonvulsants; Case-Control Studies; Dose-Response Relationship, Drug; Female; Fructose; Humans; Male; Migraine Disorders; Myopia; Prognosis; Refraction, Ocular; Topiramate; Vision Tests; Visual Acuity

Topics: Anticonvulsants; Child; Fructose; Humans; Male; Myopia; Retinal Diseases; Tomography, Optical Coherence; Topiramate; Visual Acuity

We present a case of late acute myopia syndrome following discontinuation of treatment with a combination of sulphonamide drugs. To the best of our knowledge, this is the first reported case with such a presentation, and suggests that the pathophysiological basis for the acute myopia syndrome is a rapid decrease in serum carbonic anhydrase inhibitors levels which may lead to a rebound increase in the production of aqueous humor and accumulation of suprachoroidal fluid. It is further postulated that there may be a cumulative effect of sulphonamide drug use on carbonic anhydrase activity in the ciliary body epithelium of susceptible individuals.

Topics: Acute Disease; Adult; Anti-Infective Agents; Anticonvulsants; Drug Therapy, Combination; Female; Fructose; Humans; Intraocular Pressure; Migraine Disorders; Myopia; Pharyngitis; Topiramate; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Anticonvulsants; Female; Fructose; Humans; Migraine Disorders; Myopia; Topiramate; Vision Disorders; Visual Acuity

Topiramate is a drug which emerged from its anticonvulsant properties and now over the years is used for a wider range of indications, including migraine prophylaxis. We described a very rare case of topiramate induced acute onset myopia during use for migraine. It is the first reported case of its kind from Sri Lanka with only a handful of reported cases in world literature.. A 35-year-old Sri Lankan female presented with long standing history of intermittent headache with recent worsening. A diagnosis of migraine was made and due to poor response to other medication was initiated on topiramate. Two weeks later patient developed visual impairment which was finally attributed to topiramate. Following discontinuation of the drug, within 3 days the symptoms started to improve with full recovery in 10 days.. All clinicians should be aware of the potential ocular side effects of topiramate. Although relatively rare, prompt recognition is key to appropriate management.

Topics: Acute Disease; Adult; Female; Fructose; Humans; Migraine Disorders; Myopia; Recovery of Function; Risk Factors; Time Factors; Topiramate; Vision, Ocular

Topics: Adult; Female; Follow-Up Studies; Fructose; Gonioscopy; Humans; Migraine Disorders; Myopia; Neuroprotective Agents; Refraction, Ocular; 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

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

Topiramate is a sulfamate-substituted monosaccharide mainly used to treat epilepsy in children and adults and prophylaxis of migraine. This article describes a case of topiramate-induced acute transient myopia. The underlying mechanism and management is discussed. A 13-year-old female complained of sudden onset of blurred vision; 7 days prior to this she had commenced topiramate therapy for migraine prophylaxis. Visual acuity was reduced in both eyes. Examination revealed myopic refractive changes which resolved quickly following discontinuation of the drug. An MRI showed uveoscleral and subcutaneous cellular tissue abnormalities in the T1 contrasted images.

Topics: Adolescent; Contrast Media; Female; Fructose; Headache; Humans; Magnetic Resonance Imaging; Myopia; Neuroprotective Agents; 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

We report a case of acute myopic recurrence in a 38-year-old patient in a state of panic with a condition corresponding to LASIK 4 months earlier. The patient had commenced topiramate treatment 1 week previously, which is an antiepileptic drug also approved for migraine treatment. The symptoms were due to a rare topiramate-induced side effect (SE) with ciliochoroidal effusion, anterior shift of the lens-iris diaphragm and induced myopia. Cessation of topiramate led to complete remission of this idiosyncratic reaction, however, the patient's anxiety was impressive. Ocular administration of Topiramat-SE should thus be clarified.

Topics: Adult; Anticonvulsants; Female; Fructose; Humans; Keratomileusis, Laser In Situ; Myopia; Panic Disorder; Recurrence; Topiramate; Treatment Outcome

A 23-year-old woman who was seen due to decreasing far visual acuity 24hours after starting treatment with topiramate. In the cycloplegic refraction, RE showed -4.25 and LE -4.50. Retinal striae could be seen in the macula of both eyes. The alterations ceased 48hours after the drug treatment was interrupted.. Drug induced acute myopia is an infrequent phenomenon, the aetiology of which is still not fully known.

Topics: Anticonvulsants; Female; Fructose; Humans; Macula Lutea; Migraine Disorders; Mydriatics; Myopia; Retinal Diseases; Topiramate; Young Adult

Topics: Acute Disease; Adult; Anticonvulsants; Cornea; Corneal Diseases; Diagnostic Techniques, Ophthalmological; Female; Fructose; Humans; Myopia; Photography; Topiramate

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: Adult; Anticonvulsants; Depression; Female; Fructose; Humans; Myopia; 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

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

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

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

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

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

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

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

Topics: Adult; Female; Fructose; Headache; Humans; Myopia; Topiramate

Topics: Acute Disease; Adolescent; Anticonvulsants; Fructose; Fundus Oculi; Humans; Male; Myopia; Retinal Diseases; Topiramate; Visual Acuity

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

Topics: Adult; Anticonvulsants; Drug Therapy, Combination; Epilepsy; Female; Fructose; Humans; Myopia; Topiramate