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Topiramate-associated acute, bilateral, secondary angle-closure glaucoma

2004; Elsevier BV; Volume: 111; Issue: 1 Linguagem: Inglês

10.1016/j.ophtha.2003.04.004

1549-4713

FW Fraunfelder, Frederick T. Fraunfelder, Edwin U. Keates,

Cancer Treatment and Pharmacology

Abstract Purpose To evaluate spontaneous reports of ocular side effects associated with topiramate use. Design Retrospective case series. Methods One hundred fifteen case reports, primarily of a specific ocular syndrome (acute secondary angle-closure glaucoma), were collected from spontaneous reporting systems: the Drug Safety section of Ortho-McNeil Pharmaceuticals, Inc. (Raritan, NJ), the Food and Drug Administration (Rockville, MD), the World Health Organization (Uppsala, Sweden), the National Registry of Drug-Induced Side Effects (Casey Eye Institute, Oregon Health & Science University, Portland, Oregon), and the world literature. Main outcome measures The data were evaluated using the World Health Organization Causality Assessment Guide to the certainty of a suspected adverse drug reaction. Results Eighty-six cases of acute-onset glaucoma (83 bilateral and 3 unilateral), 17 cases of acute bilateral myopia (up to 8.75 diopters), 9 cases of suprachoroidal effusions, 3 cases of periorbital edema, and 4 cases of scleritis were reported. In those cases for which management was reported, 38% had laser or surgical peripheral iridectomy (21 cases). Conclusions In the "certain" category of the World Health Organization classification system, the following are caused by topiramate therapy: abnormal vision, acute secondary angle-closure glaucoma, acute myopia, and suprachoroidal effusions. All findings are reversible if recognized early and if the drug is discontinued. The first presenting symptom of acute secondary angle-closure glaucoma in many patients was blurring of vision. Peripheral iridectomy is ineffective for this type of angle-closure glaucoma.