topiramate and Retinal-Detachment

A 36 year-old woman with idiopathic intracranial hypertension was treated with topiramate and acetazolamide. The patient was followed-up for 2 years, with a relationship between neurosensory detachments and topiramate being established, with recurrences after the introduction of topiramato and improvement after its withdrawal. These findings point topiramate as a possible cause of the clinical picture. Topiramate may cause retinal and macular neurosensory detachments. Although the ciliochoroidal effusion cases caused by this drug are well-known, its retinal side effects are less common. As it is a widely used drug, neurologists and ophthalmologists should be aware of its possible ocular side effects.

Topics: Acetazolamide; Adult; Antihypertensive Agents; Female; Fundus Oculi; Humans; Intracranial Hypertension; Macula Lutea; Recurrence; Retinal Detachment; 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