Blood-brain barrier disruption associated with topiramate-induced angle-closure glaucoma of acute onset.
BACKGROUND
Topiramate (Topamax(R)) is an anti-epileptic drug of the sulfamate group used secondarily for bipolar disease.


METHODS
One week after initiation of topiramate treatment for a bipolar disorder, a 57-year-old man presented with blurred vision. Clinical examination revealed a bilateral conjunctivitis, areflexic mydriasis, severe anterior chamber shallowing, with a myopic shift and vitritis.


RESULTS
A spinal tap revealed an increased protein content of 1581 mg/L on cerebrospinal fluid (CSF) analysis, being compatible with a rupture of the blood-brain barrier (BBB). UBM exposed bilateral ciliochoroidal effusions with secondary angle-closure. Topiramate was promptly discontinued, whereas visual acuity, intraocular pressure (IOP), and anterior and posterior segments anatomy normalized within 1 week. One month later, bilateral iris atrophy was present.


CONCLUSIONS
The presence of BBB disruption with increased protein content in CSF with simultaneous blood ocular barrier breakdown may suggest a common inflammatory mechanism.
Viet Tran
H
H
Jules Gonin University Eye Hospital, Lausanne, Schweiz.
Ravinet
E
E
Schnyder
C
C
Reichhart
M
M
Guex-Crosier
Y
Y
D000208:Acute Disease; D000927:Anticonvulsants / Q000009:adverse effects; D001812:Blood-Brain Barrier / Q000187:drug effects* / Q000473:pathology*; D005632:Fructose / Q000009:adverse effects / Q000031:analogs & derivatives*; D015812:Glaucoma, Angle-Closure / Q000139:chemically induced* / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009216:Myopia / Q000139:chemically induced* / Q000175:diagnosis*; D000077236:Topiramate
D000927:Anticonvulsants; D000077236:Topiramate; D005632:Fructose