[Bilateral acute angle closure glaucoma in a young patient receiving oral topiramate: case report].
This paper reports a clinical case of uveal effusion in both eyes causing bilateral acute angle closure glaucoma in a young patient after oral administration of topiramate, a new anticonvulsant medication. Rarely, some drugs have produced uveal effusions, forward shift of the iris-lens diaphragm, transient myopia and secondary angle closure glaucoma. A 40-year old white woman was seen at the emergency department of the "Hospital Banco de Olhos de Porto Alegre (RS)"--Brazil, with severe headaches and blurry vision in both eyes. Her medications included topiramate, started 10 days before. Slit lamp examination revealed conjunctival injection, chemosis and shallow anterior chambers. Intraocular pressure measured 40 and 38 mmHg. Fundoscopic examination findings were normal. Ultrasound scan was performed and demonstrated separation between the choroidal layer and the sclera. A diagnosis of bilateral uveal effusion associated with the use of oral topiramate was made. Topiramate was then discontinued. The patient reported symptomatic improvement by the third day after initial examination. Symptoms were resolved and visual acuity returned to normal. Topiramate may cause ciliary body edema and relaxation of zonules, which induces a forward shift of the lens-iris diaphragm with acute myopia and angle closure. As the mechanism of angle closure does not involve pupillary block, peripheral iridectomy and topical miotics are not useful in the treatment of this type of secondary angle-closure glaucoma. Drug-induced uveal effusions occur rarely. The patient improved after topiramate discontinuation.
Stangler
Fausto
F
Hospital Banco de Olhos de Porto Alegre, Rua Eng. Walter Boehl 285, Porto Alegre, RS, CEP 91360-090, Brazil.
Prietsch
Roberta Fernandez
RF
Fortes Filho
João Borges
JB
D000208:Acute Disease; D000927:Anticonvulsants / Q000009:adverse effects*; D005260:Female; D005632:Fructose / Q000009:adverse effects / Q000031:analogs & derivatives*; D015812:Glaucoma, Angle-Closure / Q000139:chemically induced* / Q000188:drug therapy; D006801:Humans; D008875:Middle Aged; D000077236:Topiramate; D014792:Visual Acuity
D000927:Anticonvulsants; D000077236:Topiramate; D005632:Fructose