TOPIRAMATE-INDUCED BILATERAL ANGLE-CLOSURE GLAUCOMA. A CASE REPORT

Česká verze

Authors: L. Magera; AD. Baxant; P. Studený
Authors place of work: Oftalmologická klinika, Fakultní nemocnice Královské Vinohrady a 3. Lékařská fakulta Univerzity Karlovy, Praha
Published in the journal: Čes. a slov. Oftal., 78, 2022, No. 3, p. 138-142
Category: Kazuistika
doi: https://doi.org/10.31348/2022/16

Summary

Introduction: Topamax (topiramate) is a drug used in the treatment of epilepsy or migraine. Its use may rarely be associated with the occurrence of secondary angle-closure glaucoma due to supraciliary effusion. Although the ocular finding resembles primary angle-closure glaucoma, bilateral infliction should always raise the suspicion that it is drug-induced glaucoma.

Case report: The authors present a case of a 51-year-old patient on Topamax therapy with sudden vertigo, headache and blurred vision. Ophthalmic examination revealed bilateral angle-closure glaucoma, which was initially treated in the classical manner by administration of local antiglaucoma drugs and pilocarpine, followed by administration of osmotically active substances and laser iridotomy. Only the subsequent discontinuation of Topamax and the use of local cycloplegics and corticosteroids led to the release of the anterior segment angle closure and normalization of intraocular pressure.

Conclusion: The indicating physician and ophthalmologist must be aware of the possible side effects of Topamax therapy to determine the correct diagnosis and to administer treatment appropriately.

Keywords:

Migraine – Epilepsy – topiramate – topamax – angle-closure glaucoma – acute myopia

Zdroje

1. Shank RP, Maryanoff BE. Molecular pharmacodynamics, clinical therapeutics, and pharmacokinetics of topiramate. CNS Neurosci Ther. 2008;14(2):120-142.

2. Flores-Sánchez BC, Tatham AJ. Acute angle closure glaucoma. Br J Hosp Med (Lond). 2019;80(12):174-179.

3. Sun X, Dai Y, Chen Y, et al. Primary angle closure glaucoma: What we know and what we don’t know. Prog Retin Eye Res. 2017;57:26-45.

4. Štěpánková J, Kinštová L, Gažová I, et al. Simultaneous bilateral acute angle-closure glaucoma in Miller Fisher syndrome. Cesk Slov Oftalmol. 2019;75(4):210-218.

5. Lachkar Y, Bouassida W. Drug-induced acute angle closure glaucoma. Curr Opin Ophthalmol. 2007;18(2):129-133.

6. Fraunfelder FW, Fraunfelder FT, Keates EU. Topiramate-associated acute, bilateral, secondary angle-closure glaucoma. Ophthalmology. 2004;111(1):109-111.

7. Leung DYL, Leung H, Baig N, et al. Topiramate and asymptomatic ocular angle narrowing: a prospective pilot study. Eye (Lond). 2009;23(11):2079-2081.

8. Symes RJ, Etminan M, Mikelberg FS. Risk of angle-closure glaucoma with bupropion and topiramate. JAMA Ophthalmol. 2015;133(10):1187-1189.

9. Vetvik KG, MacGregor EA. Sex differences in the epidemiology, clinical features, and pathophysiology of migraine. Lancet Neurol. 2017;16(1):76-87.

10. Reddy DS. The neuroendocrine basis of sex differences in epilepsy. Pharmacol Biochem Behav. 2017;152:97-104.

11. Gopalakrishna M, Odayappan A, Srinivasan K, Rengaraj V. A case series of topiramate-induced angle closure crisis - an ophthalmic emergency. Cephalalgia. 2020;40(12):1389-1393.

12. Czyz CN, Clark CM, Justice JD, Pokabla MJ, Weber PA. Delayed topiramate- induced bilateral angle-closure glaucoma. J Glaucoma. 2014;23(8):577-578.

13. Lan YW, Hsieh JW. Bilateral acute angle closure glaucoma and myopic shift by topiramate-induced ciliochoroidal effusion: case report and literature review. Int Ophthalmol. 2018;38(6):2639-2648.

14. Acharya N, Nithyanandam S, Kamat S. Topiramate-associated bilateral anterior uveitis and angle closure glaucoma. Indian J Ophthalmol. 2010;58(6):557-559.

15. Viet Tran H, Ravinet E, Schnyder C, Reichhart M, Guex-Crosier Y. Blood-brain barrier disruption associated with topiramate-induced angle-closure glaucoma of acute onset. Klin Monbl Augenheilkd. 2006;223(5):425-427.

16. van Issum C, Mavrakanas N, Schutz JS, Shaarawy T. Topiramate-induced acute bilateral angle closure and myopia: pathophysiology and treatment controversies. Eur J Ophthalmol. 2011;21(4):404-409.

17. Kamal S, Yadava U, Kumar S, Goel R. Topiramate-induced angle-closure glaucoma: cross-sensitivity with other sulphonamide derivatives causing anterior uveitis. Int Ophthalmol. 2014;34(2):345-349.