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. 2004 Jan;111(1):109-11.
doi: 10.1016/j.ophtha.2003.04.004.

Topiramate-associated Acute, Bilateral, Secondary Angle-Closure Glaucoma


Topiramate-associated Acute, Bilateral, Secondary Angle-Closure Glaucoma

F W Fraunfelder et al. Ophthalmology. .


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.

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