Topiramate angle-closure glaucoma

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. 

Fratmfelder FW, Fraunfelder FT, Keates EU.Topiramate-associated acute, bilateral, secondary angle-closure glaucoma. Ophthalmology 2004 111 109-111. 

Rhee DJ, Ramos-Esteban JC, Nipper KS. Rapid resolution of topiramate-induced angle-closure glaucoma with methylpred-nisolone and mannitol. Am J Ophthalmol 2006 141 1133-1134. 

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 The symptoms are reversible if topiramate is withdrawn.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. 

Sankar PS, Pasquale LR, Grosskreutz CL. Uveal effusion and secondary angle-closure glaucoma associated with topiramate use. Arch Ophthalmol 2001 119(8) 1210-11. 

Rhee DJ, Goldberg MJ, Parrish RK. Bilateral angle-closure glaucoma and ciliary body swelling from topiramate. Arch Ophthalmol 2001 119(ll) 1721-3. 

Banta JT, Hoffman K, Budenz DL, Ceballos E, Greenfield DS. Presumed topiramate-induced bilateral acute angle-closure glaucoma. Am J Ophthalmol 2001 132(1) 112-14. 

Sensory systems Bilateral severe uveitis with angle-closure glaucoma, a rare complication of topiramate therapy, has been reported in a 49-year-old man [291 ]. 

Acharya N, Nithyanandam S, Kamat S. Topiramate-associated bilateral anterior uveitis and angle closure glaucoma. Indian J Ophthalmol 2010 58(6) 557-9. 

Tahiri Joutei Hassani R, Dupont Monod S, Oukacha G, Mantout F, Benrabah R, Heron E, Baudouin C. Acute bilateral angle-closure glaucoma induced by topiramate contribution of Visante OCT. J Fr Ophtalmol 2010 33(5) 307-11. 

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

Five patients with topiramate associated bilateral acute angle-closure glaucoma unresponsive to ocular hypotensive therapy and drug discontinuation were effectively treated with argon laser peripheral iridoplasty [336 337 ]. 

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. 

Zalta AH, Smith RT. Peripheral iridoplasty efhcacy in refractory topiramate-associated bilateral acute angle-closure glaucoma. Arch Ophthalmol 2008 126(11) 1603-5. 

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. 

Chen TC, Chao CW, Sorkin JA. Topiramate induced myopic shift and angle closure glaucoma. Br J Ophthalmol 2003 87(5) 648-9. 

Sbeity Z, Gvozdyuk N, Amde W, Liebmann JM, Ritch R. Argon laser peripheral iridoplasty for topiramate-induced bilateral acute angle closure. J Glaucoma 2009 18(4) 269-71. 

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