Topiramate-associated acute, bilateral, secondary 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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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.