Rapid resolution of topiramate-induced angle-closure glaucoma with methylprednisolone and mannitol.
OBJECTIVE
Topiramate-induced angle-closure glaucoma (TiACG) is believed to be related to its sulfonamide moiety. Although the exact mechanism is unknown, the time course and constellation of symptoms are consistent with a possible inflammatory pathophysiologic condition.


METHODS
Interventional case report.


METHODS
We report the clinical outcome of a case of TiACG that was associated with an extreme intraocular pressure elevation of >60 mm Hg that was treated with the combination of systemic mannitol and methylprednisolone.


RESULTS
The combination of the two systemic medications resulted in the resolution of the attack with a much more rapid time course than is seen typically for extreme cases of TiACG. Mannitol treatment alone did not lower the intraocular pressure after 90 minutes, although improvement was noted four hours after methylprednisolone.


CONCLUSIONS
For severe cases of TiACG that are associated with very high intraocular pressures, the combination of mannitol and methylprednisolone can induce a rapid improvement. Inflammation may be a component of TiACG.
Rhee
Douglas J
DJ
William and Anna Goldberg Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA. dougrheee@aol.com
Ramos-Esteban
Jerome C
JC
Nipper
Karen S
KS
D000328:Adult; D000869:Anterior Eye Segment / Q000000981:diagnostic imaging; D004234:Diuretics, Osmotic / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005632:Fructose / Q000009:adverse effects / Q000031:analogs & derivatives*; D015812:Glaucoma, Angle-Closure / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000188:drug therapy*; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects; D008353:Mannitol / Q000627:therapeutic use*; D008775:Methylprednisolone / Q000627:therapeutic use*; D033401:Microscopy, Acoustic; D000077236:Topiramate; D014792:Visual Acuity / Q000187:drug effects
D004234:Diuretics, Osmotic; D005938:Glucocorticoids; D000077236:Topiramate; D005632:Fructose; D008353:Mannitol; D008775:Methylprednisolone