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Abstract #10423 Published in IGR 6-1
Topiramate-associated acute, bilateral, secondary angle-closure glaucoma
Fraunfelder FW; Fraunfelder FT; Keates EUOphthalmology 2004; 111: 109-111
PURPOSE: To evaluate spontaneous reports of ocular side effects associated with topiramate use. DESIGN: Retrospective case series. METHODS: One hundred and fifteen case reports, primarily of a specific ocular syndrome (acute secondary angle-closure glaucoma), were collected from spontaneous reporting systems: the Drug Safety section of Ortho-McNeil Pharmaceuticals, Inc. (Raritan, NJ), the Food and Drug Administration (Rockville, MD), the World Health Organization (Uppsala, Sweden), the National Registry of Drug-Induced Side Effects (Casey Eye Institute, Oregon Health & Science University, Portland, Oregon), and the world literature. MAIN OUTCOME MEASURES: The data were evaluated using the World Health Organization Causality Assessment Guide to the certainty of a suspected adverse drug reaction. RESULTS: Eighty-six cases of acute-onset glaucoma (83 bilateral and three unilateral), 17 cases of acute bilateral myopia (up to 8.75 D), nine cases of suprachoroidal effusions, three of periorbital edema, and four of scleritis were reported. In those cases for which management was reported, 38% had laser or surgical peripheral iridectomy (21 cases). CONCLUSIONS: In the 'certain' category of the World Health Organization classification system, the following are caused by topiramate therapy: abnormal vision, acute secondary angle-closure glaucoma, acute myopia, and suprachoroidal effusions. All findings are reversible if recognized early and if the drug is discontinued. The first presenting symptom of acute secondary angle-closure glaucoma in many patients was blurring of vision. Peripheral iridectomy is ineffective for this type of angle-closure glaucoma.
Dr. F.W. Fraunfelder, The Casey Eye Institute, Oregon Health & Science University, Portland, OR 97201, USA. fraunfer@ohsu.edu
Classification:
9.3.10 Other (Part of: 9 Clinical forms of glaucomas > 9.3 Primary angle closure glaucomas)
