Exudative Retinal Detachments: A Rare Adverse Effect of Topiramate

Topiramate-induced multifocal exudative retinal detachment is a rare but potentially vision-threatening adverse effect. We report a 59-year-old woman with idiopathic intracranial hypertension who developed painless bilateral blurry vision and color desaturation 8 days after initiation of topiramate 25 mg twice daily. Fundus examination and spectral-domain optical coherence tomography demonstrated bilateral multifocal exudative retinal detachment with subretinal fluid. Extensive infectious and inflammatory investigations were unremarkable. Topiramate was discontinued, resulting in complete anatomical resolution of subretinal fluid and improvement of visual acuity to 20/30 in both eyes over 3 months of follow-up. This case highlights the importance of recognizing this uncommon ocular complication and the potential for complete recovery following prompt drug cessation.