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Abstract #46096 Published in IGR 13-2
Topiramate-induced acute bilateral angle closure and myopia: Pathophysiology and treatment controversies
Issum C; Mavrakanas N; Schutz JS; Shaarawy TEuropean Journal of Ophthalmology 2011; 21: 404-409
Purpose. To discuss the unusual features of topiramate-induced acute angle closure glaucoma, its pathophysiologic mechanisms, and treatment controversies, and to report the first anterior segment optical coherence tomography (OCT) of this condition. Methods. Literature review and case report with OCT findings. Results. Topiramate-induced angle closure is usually bilateral and associated with acute myopia; the ocular pressure is often not very highly elevated. Ciliochoroidal detachment with ciliary body anterior rotation is typically present and was demonstrated easily in our case with anterior segment OCT. Pilocarpine exacerbates this condition and peripheral iridotomy is not indicated, nor is iridoplasty. Treatment consists of replacing topiramate with appropriate medication, strong cycloplegia, and topical steroids. Conclusions. It is important to recognize this form of acute secondary angle closure in order to treat it properly, avoiding harmful medication and unnecessary surgery.
T. Shaarawy. Glaucoma Sector, Ophthalmology Department, Geneva University Hospitals, 22 Alcide-Jentzer str. 1211, Geneva 14, Switzerland. Email: tarek.shaarawy@hcuge.ch
Classification:
9.3.1 Acute primary angle closure glaucoma (pupillary block) (Part of: 9 Clinical forms of glaucomas > 9.3 Primary angle closure glaucomas)
9.4.5.5 Other (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders > 9.4.5 Glaucomas associated with disorders of the retina, choroid and vitreous)
8.1 Myopia (Part of: 8 Refractive errors in relation to glaucoma)
