Myopia topiramate

Topiramate is recently approved by the FDA for migraine prophylaxis. Dose is initiated at 25 mg/day and increased slowly to minimize side effects, which may include paresthesias, fatigue, anorexia, diarrhea, weight loss, difficulty with memory, and nausea. Kidney stones, acute myopia, acute angle-closure glaucoma, and oligohidrosis have been infrequently reported. 

Eighty-five percent of the 86 cases of mostly bilateral acute angle-closure glaucoma reported to the National Registry of Drug-Induced Ocular Side Effects by 2003 were noted to have occurred within the first 2 weeks of treatment initiation. Topiramate is considered to have certain OADRs in the form of abnormal vision, acute secondary angle-closure glaucoma, acute myopia, and suprachoroidal effusions. 

Topiramate is used as adjunctive treatment for partial seizures, with or without secondary generalisation. It use is limited by its unwanted effects, particularly sedation, naming difficulty and weight loss. Acute myopia and raised intraocular pressure may occur. 

On 26 September 2001 OrthoMacneil/Jansen-Cilag issued a Dear Doctor letter about an ocular syndrome in patients taking topiramate. The syndrome is characterized by acute myopia and secondary angle-closure glaucoma. Several case reports have been published (22-24). 

As of 17 August 2001 there were 23 reported cases (22 adults and 1 child) out of 825 000 patients. Symptoms typically occur within the first month of therapy, and the patients report acutely reduced visual acuity and/or ocular pain. There is myopia, redness, swelling of the anterior chamber, and raised ocular pressure, with or without pupil dilatation. Supraciliary effusion can displace the lens and iris anteriorly, secondarily causing angle-closure glaucoma. The symptoms are reversible if topiramate is withdrawn. Acute myopia has been described as a rare idiosyncratic reaction to other sulfonamides. It has been postulated that the pathogenic mechanism is related to partial inhibition of carbonic anhydrase and to ciliary body swelling. 

Craig JE, Ong TL, Lousi DL, et ai. Mechanism of topiramate-induced acute-onset myopia and angie ciosure giaucoma. Am J Ophthaimoi 2004 137 193-195. 

Sensory systems There have been several cases of angle-closure glaucoma and/or acute myopia associated with topiramate [306, 307, 308 ]. 

Brandao MN, Fernandes IC, Barradas FF, Machado JF, Oliveira MT. Acute myopia and angle closure glaucoma associated with topiramate use in a young patient case report. Arq Bras Oftalmol 2009 72 (1) 103-5. 

Boonyaleephan S. Bilateral acute onset myopia and angle closure glaucoma after oral topiramate a case report. J Med Assoc Thai 2008 91(12) 1904-7. 

Gawley SD. Topiramate induced acute transient myopia a case report. Cases J 2009 2 7430. 

Cereza G, Pedros C, Garcia N. Topiramate in nonapproved indications and acute myopia or angle closure glaucoma. Br J Clin Pharmacol 2005 60(5) 578-9. 

Desai CM, Ramchandani SJ, Bhopale SG, Ramchandani SS. Acute myopia and angle closure caused by topiramate, a drug used for prophylaxis of migraine. Indian J Ophthalmol 2006 54(3) 195-7. 

A 41-year-old woman developed acute bilateral myopia 12 days after starting topiramate without an acute rise in intraocular pressure. The medication was discontinued and she was treated prophylactically with acetazolamide, with complete recovery [165 ]. 

Gazieva L, Thomassen VH, Kaas-Hansen M, Baggesen K. Topiramate-induced acute bilateral myopia. Acta Ophthalmol June 2013 91(4) e332. ... 

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