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Presumed topiramate-induced bilateral acute angle-closure glaucoma.
J T Banta1, K Hoffman, D L Budenz
1Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida, USA.
American Journal of Ophthalmology
|July 5, 2001
Summary
Oral topiramate therapy can cause bilateral angle-closure glaucoma. This condition, characterized by ciliary body edema and lens thickening, resolved after discontinuing the medication.
Area of Science:
- Ophthalmology
- Pharmacology
Background:
- Topiramate is an antiepileptic drug with a sulfa derivative structure.
- Angle-closure glaucoma is an ocular condition characterized by increased intraocular pressure due to blockage of the anterior chamber angle.
Observation:
- A 51-year-old male patient initiated oral topiramate for bipolar disorder.
- Within two weeks, the patient developed bilateral acute angle-closure glaucoma.
- Echography demonstrated lens thickening and ciliochoroidal detachments in both eyes.
Findings:
- Laser peripheral iridotomy in the right eye did not resolve the acute attack.
- Cessation of topiramate therapy led to normalization of visual acuity, intraocular pressure, and ocular anatomy within two weeks.
- The adverse event was attributed to idiosyncratic ciliochoroidal detachments and ciliary body edema induced by topiramate.
Implications:
- Topiramate may induce angle-closure glaucoma through ciliochoroidal effusions and lens swelling.
- Ophthalmologists should consider topiramate as a potential cause of acute angle-closure glaucoma in patients using this medication.
- Early recognition and discontinuation of topiramate are crucial for managing this iatrogenic ocular condition.