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Refractory topiramate-induced angle-closure glaucoma in a man: a case report
Matthew C Willett1, Deepak P Edward
1Summa Health Systems, 75 Arch St, Suite 512, Akron, OH 44304, USA. deepak.edward@gmail.com.
Journal of Medical Case Reports
|January 29, 2011
Summary
Topiramate can cause angle-closure glaucoma, a rare side effect. Prompt treatment with intravenous methylprednisolone can be effective for this condition, even when conventional therapies fail.
Area of Science:
- Ophthalmology
- Neurology
- Pharmacology
Background:
- Topiramate, a sulphonamide derivative, is used for epilepsy and migraine.
- An idiosyncratic reaction to topiramate can cause angle-closure glaucoma.
- This case report details unusual clinical features of bilateral topiramate-induced glaucoma.
Purpose of the Study:
- To describe a unique case of bilateral angle-closure glaucoma induced by topiramate.
- To highlight the potential efficacy of intravenous methylprednisolone in refractory cases.
- To emphasize the delayed resolution of visual symptoms, including myopic shift.
Main Methods:
- A 39-year-old male presented with acute angle-closure glaucoma after escalating topiramate dosage.
- Clinical examination revealed elevated intraocular pressure, shallow anterior chambers, and bilateral choroidal effusions.
- Treatment involved intravenous methylprednisolone combined with standard glaucoma management.
Main Results:
- Rapid reduction in intraocular pressure was achieved with the combined treatment.
- Gradual, delayed resolution of choroidal effusions and induced myopic shift occurred.
- The patient experienced a favorable outcome with no optic nerve damage.
Conclusions:
- Recognizing topiramate-induced glaucoma is crucial, even in non-ophthalmic settings.
- Intravenous methylprednisolone offers a valuable treatment option for refractory cases.
- Delayed resolution of myopic shift necessitates awareness despite normalized intraocular pressure.
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