Topiramate induced bilateral hypopyon uveitis and choroidal detachment: a report of two cases and review of literature (original) (raw)

Is uveitis associated with topiramate use? A cumulative review

Clinical Ophthalmology, 2016

Occasional reports of uveitis following topiramate use necessitated an investigation of relevant cases from safety databases and published biomedical literature. Data mining of the Food and Drug Administration Adverse Event Reporting System and cumulative review of cases from the global safety database (sponsor database) and published literature were conducted to assess association between topiramate use and uveitis. The Food and Drug Administration Adverse Event Reporting System search identified disproportional reporting of uveitis (n=23) and related terms (choroidal detachment, n=25; iridocyclitis, n=17). The postmarketing reporting frequency of uveitis and related events from the global safety database and based on an estimated topiramate exposure of 11,185,740 person-years from launch to April 2015 was 0.38 per 100,000 person-years and assigned as very rare. A total of 14 potential uveitis cases were identified from the cumulative review. Seven of these 14 cases were complicated by inadequate documentation, appearance of uveitic signs following drug withdrawal, or concurrent use of other sulfonamides. In acute angle-closure glaucoma and uveal effusions cases, insufficient evidence for underlying inflammation suggested that uveitis was not a component. Only seven of 14 cases were well documented, potentially topiramate-associated uveitis cases. Uveitis may occur in the setting of topiramate use only in very rare instances. Current evidence did not reveal a dose-or duration-dependent relationship between uveitis and topiramate use.

Secondary Bilateral Angle Closure Glaucoma due to Topiramate

2011

Copyright © 2011 Miguel Paciuc-Beja et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We examined a 39-year-old female with severe headache and blurred vision. She was on topiramate, 50mg once a day for one week because of migraine. Periorbital edema, chemosis, myopia, high intraocular pressures, and shallow anterior chambers were present at the initial examination. Iridocorneal angles were closed, ultrasound showed choroidal effusions. We stopped topiramate and started antiglaucoma treatment. After one week the intraocular pressure was 10mmHg in both eyes without treatment. A new ultrasound showed no choroidal effusions. Topiramate has been associated with acute secondary angle closure glaucoma as an idiosyncratic reaction to the drug. Physicians prescribing topiramate need to alert patients of this potential sig...

Topiramate-induced bilateral acute angle closure glaucoma and myopic shift

International Journal of Basic & Clinical Pharmacology, 2014

Topiramate (TPM) shows idiosyncratic adverse reaction of peripheral ciliochoroidal effusion leading to acute angle closure glaucoma (AACG), which should be diagnosed and managed at the earliest to prevent irreversible visual loss. We report, a case of TPM-induced bilateral AACG and myopic shift, which was reversed by omitting TPM and administering antiglaucoma medications.

Massive Bilateral Choroidal Detachment Induced by Administration of Topiramate

2011

Topiramate is a sulfa-derivative antiepileptic drug which is also used for other indications such as essential tremor. A 79-year-old male was admitted to our center due to acute bilateral painless decline of vision. One month before admission, he had experienced essential tremor and treatment with topiramate 50 mg/day and propranolol 40 mg/day. Best-corrected visual acuity was 20/800 OD and 20/600 OS. Both eyes had normal anterior chamber depths and irides. Intraocular pressure was 10 mm Hg in the right eye and 11 mm Hg in the left eye. Retinal examination showed notable choroidal detachments in all quadrants of the periphery, which were confirmed by ultrasonography. Refraction showed no myopic shift. The administration of topiramate was discontinued as a potential causative agent for this condition. During follow-up, choroidal detachment and visual acuity gradually resolved. In this study, we described the first case of isolated massive choroidal detachment induced by topiramate.

A Rare Case of Unilateral Progressive Cataract in a Young Patient Receiving Topiramate

Case Reports in Ophthalmology, 2020

This case report presents an instance of unilateral cataract formation and its rapid progression following topiramate-induced bilateral acute angle closure. An 18-year-old female diagnosed with acute angle closure in both eyes had started treatment on the previous day at another healthcare facility. The patient presented with complaints of pain, sudden diminution of vision, excessive watering, and photophobia (both eyes) and reported the use of topiramate for headache for 10 days. There was no past history of decreased vision, trauma, uveitis, or use of steroids. Topiramate-induced bilateral secondary angle closure attack was the presumptive diagnosis. Topiramate use was stopped, and antiglaucoma drugs, topical cycloplegic, and topical steroids were started. On 1-day follow-up, clearer cornea and peripheral anterior capsular lenticular opacity of the right eye were observed. Gonioscopy showed closed angles. Anterior segment optical coherence tomography showed forward movement of the...

Topiramate Induced Bilateral Simultaneous Angle Closure Glaucoma in A Steroid Responde

To report a case of topiramate induced bilateral simultaneous angle closure glaucoma in a young male patient who also developed steroid response following conventional treatment ie, cessation of the causative drug (Topiramate),topical and oral steroids along with antiglaucoma medication. There was an initial drop in Intra-ocular Pressure (IOP) subsequently followed by a secondary rise in IOP due to steroid response despite the resolution of topiramate induced bilateral ciliochoroidal effusions.

Topiramate Associated Bilateral Acute Angle Closure Glaucoma And Myopia

The Internet Journal of Ophthalmology and Visual Science

Topiramate, an oral sulphamate medication, is primarily licensed for treating epilepsy, though it is increasingly being used for treating migraine1. Studies have also established its role in treating cocaine addiction2. Topiramate is thought to potentiate the activity of GABA (-aminobutyric acid) neurotransmitter by blocking the glutamate receptors3. It also has a weak carbonic anhydrase inhibitory activity. We describe a case of acute myopia and angle closure glaucoma secondary to topiramate, used for the treatment of migraine.

Topiramate-induced Acute Transient Myopia and Angle Narrowing

Journal of the College of Physicians and Surgeons Pakistan, 2021

Sulphamate drugs, widely prescribed for various systemic conditions, are reported to have rare ocular adverse-effects, usually within weeks of initiation of treatment. Medical and drug history in such cases are of pivotal importance in reaching a proper diagnosis. This study reports three cases, which developed topiramate-induced ocular side effects. In one of the cases, although the angles were narrow in both eyes, yet intra-ocular pressure (IOP) was not high. Also, in the third case, there were no macular striae. Topiramate was immediately withheld and all cases were improved without any permanent ocular damage.