title: Bilateral angle closure following use of a weight loss combination agent containing topiramate.
abstract: OBJECTIVE
  To report a unique case of topiramate-induced bilateral angle closure following ingestion of a recently introduced weight loss medication containing topiramate, and to describe its management.
  
  
  METHODS
  Case report of a 39-year-old, otherwise healthy woman who experienced decreased vision, bilateral acute angle closure, choroidal thickening as measured with enhanced depth optical coherence tomography imaging, bilateral suprachoroidal effusions, and induced myopia 1 week after starting a weight loss medication, Qysmia, composed of phentermine 3.75 mg and topiramate 23 mg. Treatment was initiated with high-dose intravenous methylprednisolone, intravenous mannitol, topical difluprednate ophthalmic emulsion, atropine sulfate, and the fixed combination of brimonidine and timolol. At the 2-week follow-up visit, vision, intraocular pressure, and angle anatomy had returned to normal and there was resolution of choroidal and ciliary body effusions on ultrasound biomicroscopy.
  
  
  CONCLUSIONS
  Bilateral acute angle closure may develop after ingestion of weight loss drugs containing topiramate.
authors.affiliation: *Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL †Cincinnati Eye Institute, University of Cincinnati, Cincinnati, OH.
authors.forename: Dilraj S
authors.initials: DS
authors.lastname: Grewal
authors.forename: Debra A
authors.initials: DA
authors.lastname: Goldstein
authors.forename: Anup K
authors.initials: AK
authors.lastname: Khatana
authors.forename: Angelo P
authors.initials: AP
authors.lastname: Tanna
mesh_terms: D000328:Adult; D019440:Anti-Obesity Agents / Q000009:adverse effects*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D000068438:Brimonidine Tartrate; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005260:Female; D005632:Fructose / Q000009:adverse effects / Q000031:analogs & derivatives*; D015812:Glaucoma, Angle-Closure / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects / Q000502:physiology; D008353:Mannitol / Q000627:therapeutic use; D033401:Microscopy, Acoustic; D010645:Phentermine / Q000627:therapeutic use*; D011810:Quinoxalines / Q000627:therapeutic use; D013999:Timolol / Q000627:therapeutic use; D041623:Tomography, Optical Coherence; D014065:Tonometry, Ocular; D000077236:Topiramate; D015431:Weight Loss / Q000187:drug effects
chemical_list: D019440:Anti-Obesity Agents; D000959:Antihypertensive Agents; D004338:Drug Combinations; D011810:Quinoxalines; D000077236:Topiramate; D005632:Fructose; D008353:Mannitol; D000068438:Brimonidine Tartrate; D013999:Timolol; D010645:Phentermine