Topiramate-associated acute, bilateral, secondary angle-closure glaucoma.
OBJECTIVE
To evaluate spontaneous reports of ocular side effects associated with topiramate use.


METHODS
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.


METHODS
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.
Fraunfelder
F W
FW
The Casey Eye Institute, Oregon Health & Science University, Portland, Oregon 97201, USA. fraunfer@ohsu.edu
Fraunfelder
F T
FT
Keates
Edwin U
EU
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems / Q000706:statistics & numerical data; D000368:Aged; D000927:Anticonvulsants / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005632:Fructose / Q000009:adverse effects* / Q000031:analogs & derivatives*; D015812:Glaucoma, Angle-Closure / Q000139:chemically induced* / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D007429:Intraocular Pressure; D007498:Iris / Q000601:surgery; D053685:Laser Therapy; D008875:Middle Aged; D012042:Registries / Q000706:statistics & numerical data; D012189:Retrospective Studies; D000077236:Topiramate
D000927:Anticonvulsants; D000077236:Topiramate; D005632:Fructose