Elevated intraocular pressure and myopic shift linked to topiramate use.
OBJECTIVE
The purpose of this report is to describe acute myopia as an ocular adverse reaction to topiramate (Topamax, Ortho-McNeil, Raritan, NJ) and discuss the importance of recognizing this syndrome.


METHODS
Retrospective case report and brief review of the literature.


RESULTS
A 27-year-old female patient developed decreased vision in both eyes due to acute myopia 2 weeks of after initiating therapy with topiramate. Emergency department evaluation revealed visual acuities of 20/400 right eye and 20/200 left eye. Intraocular pressures were 33 mm Hg right eye and 26 mm Hg left eye. The anterior chambers were shallow. Retinal striae were present in the maculae. The patient stated no previous need for optical correction. However, after initiating treatment with topiramate, she refracted to approximately -5.00 D bilaterally. Ultrasound testing revealed that the patient had suprachoroidal effusions in both eyes. The symptoms and clinical findings resolved completely with discontinuation of topiramate, administration of topical atropine 1% and prednisolone acetate 1%.


CONCLUSIONS
An acute myopic shift may be the presenting sign of an idiosyncratic drug reaction that can include secondary bilateral angle closure glaucoma. This condition can occur in patients who do not have a history of anterior chamber abnormalities. Recognizing this condition and discontinuing the use of the causative drug may prevent angle closure and associated vision loss.
Guier
Christian P
CP
Department of Ophthalmology, Mayo Clinic, Jacksonville, FL 32224, USA. guier.christian@mayo.edu
D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D005632:Fructose / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D015812:Glaucoma, Angle-Closure / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects*; D008881:Migraine Disorders / Q000517:prevention & control; D009216:Myopia / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology; D018696:Neuroprotective Agents / Q000009:adverse effects* / Q000627:therapeutic use; D009887:Ophthalmoscopy; D012029:Refraction, Ocular / Q000187:drug effects; D012189:Retrospective Studies; D012720:Severity of Illness Index; D041623:Tomography, Optical Coherence; D000077236:Topiramate
D018696:Neuroprotective Agents; D000077236:Topiramate; D005632:Fructose