Topiramate-induced acute bilateral angle closure and myopia: pathophysiology and treatment controversies.
OBJECTIVE
To discuss the unusual features of topiramate-induced acute angle closure glaucoma, its pathophysiologic mechanisms, and treatment controversies, and to report the first anterior segment optical coherence tomography (OCT) of this condition.


METHODS
Literature review and case report with OCT findings.


RESULTS
Topiramate-induced angle closure is usually bilateral and associated with acute myopia; the ocular pressure is often not very highly elevated. Ciliochoroidal detachment with ciliary body anterior rotation is typically present and was demonstrated easily in our case with anterior segment OCT. Pilocarpine exacerbates this condition and peripheral iridotomy is not indicated, nor is iridoplasty. Treatment consists of replacing topiramate with appropriate medication, strong cycloplegia, and topical steroids.


CONCLUSIONS
It is important to recognize this form of acute secondary angle closure in order to treat it properly, avoiding harmful medication and unnecessary surgery.
Glaucoma Sector, Ophthalmology Department, Geneva University Hospitals, Geneva, Switzerland.
Christopher
C
van Issum
Nikolaos
N
Mavrakanas
James S
JS
Schutz
Tarek
T
Shaarawy
D000208:Acute Disease; D000328:Adult; D000869:Anterior Eye Segment / Q000000981:diagnostic imaging / Q000503:physiopathology*; D000927:Anticonvulsants / Q000009:adverse effects*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D004338:Drug Combinations; D005632:Fructose / Q000009:adverse effects / Q000031:analogs & derivatives*; D015812:Glaucoma, Angle-Closure / Q000139:chemically induced / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D009216:Myopia / Q000139:chemically induced / Q000188:drug therapy / Q000503:physiopathology*; D041623:Tomography, Optical Coherence; D000077236:Topiramate; D014463:Ultrasonography; D014792:Visual Acuity / Q000502:physiology
D000927:Anticonvulsants; D000959:Antihypertensive Agents; D004338:Drug Combinations; D000077236:Topiramate; D005632:Fructose