Topiramate-associated acute, bilateral, secondary angle-closure glaucoma

doi:10.1016/j.ophtha.2003.04.004

Ophthalmology

Volume 111, Issue 1, January 2004, Pages 109-111

https://doi.org/10.1016/j.ophtha.2003.04.004 Get rights and content

Abstract

Purpose

To evaluate spontaneous reports of ocular side effects associated with topiramate use.

Design

Retrospective case series.

Methods

One hundred 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 3 unilateral), 17 cases of acute bilateral myopia (up to 8.75 diopters), 9 cases of suprachoroidal effusions, 3 cases of periorbital edema, and 4 cases 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.

Section snippets

Materials and methods

One hundred fifteen spontaneous reports of possible ocular adverse events reported with topiramate were sent to Ortho McNeil Pharmaceuticals, Inc. (Raritan, NJ), the Food and Drug Administration (Rockville, MD), and the World Health Organization (WHO) (Uppsala, Sweden), or to the National Registry of Drug-Induced Ocular Side Effects at the Casey Eye Institute (Portland, Oregon) before October 2002. These reports were consolidated and reviewed with efforts made to prevent duplication of cases.

Pattern for topiramate-associated acute, secondary angle-closure glaucoma

Eighty-three cases of bilateral and 3 cases of unilateral acute, secondary angle-closure glaucoma were reported. The remaining cases are described later, with some case reports involving more than 1 ocular side effect. Ages varied from 3 years to 70 years, with a mean of 34 years. Doses varied from 50 mg or less (47%), 50 to 75 mg (33%), 100 mg (13%), to 100 mg or more (7%). Five cases were precipitated within hours when the dose was doubled. Onset was acute and ranged from 1 to 49 days, with a

Discussion

This entity is most accurately described as topiramate-associated, acute, bilateral, secondary angle-closure glaucoma.3 This syndrome of bilateral acute pressure elevation after topiramate use was only discovered postmarketing.1, 2, 3, 4 In our series, in which management was reported, 21 of 56 patients (38%) had laser or surgical iridectomies. This suggests that this entity could be confused with acute, pupillary block, narrow-angle glaucoma in which a peripheral iridectomy is indicated (Table

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There are more references available in the full text version of this article.

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Manuscript no. 220949.

Supported, in part, by an unrestricted grant from Research to Prevent Blindness, New York, New York, and by the National Registry of Drug-Induced Ocular Side Effects, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon.

The authors have no proprietary interest in the materials presented herein.

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Topiramate-associated acute, bilateral, secondary angle-closure glaucoma☆

Abstract

Purpose

Design

Methods

Main outcome measures

Results

Conclusions

Section snippets

Materials and methods

Pattern for topiramate-associated acute, secondary angle-closure glaucoma

Discussion

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Topiramate-associated secondary angle-closure glaucomaa case series

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