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Acetazolamide/indapamide/ topiramate Acute angle closure: 3 case reports Three patients developed bilateral acute angle closure during treatment with acetazolamide, topiramate or indapamide. A 60-year-old man underwent cataract surgery in his left eye, and treatment was started for malignant glaucoma 4 hours later. He commenced prophylactic acetazolamide tablets 250mg three times daily, with mannitol and timolol. Two days later, he presented with a 2-day history of severe pain and reduced vision in both eyes. Visual acuity was finger counting at 0.5 and 1 metre in his right and left eyes, respectively. Chemical conjunctivitis, eyelid and corneal oedema and shallow anterior chambers were also noted. Intraocular pressures (IOPs) were elevated, and B-scan ultrasonography demonstrated bilateral annular ciliochoroidal effusions. Acetazolamide was the suspected cause and was subsequently withdrawn. He continued to receive topical antiglaucomas, atropine, corticosteroids and antibacterials. His symptoms improved within 2 weeks. Visual acuity was 20/20 5 weeks after his initial surgery, and all other ocular abnormalities had resolved. A 53-year-old woman had been receiving indapamide 2.5mg [route, frequency and therapeutic indication not stated] for 1 month when she presented with a 12-hour history of severe headache and reduced bilateral visual acuity associated with pain. Eyelid oedema, shallow anterior chambers and conjunctival chemosis were noted. IOPs were elevated and gonioscopy showed closed angles. Ultrasound biomicroscopy revealed cilio-choroidal effusion in both eyes. Indapamide-induced angle closure was suspected, and indapamide was subsequently withdrawn. Mannitol and antiglaucomas were initiated, and her visual acuity was 20/20 within 5 days; all other symptoms had also resolved. A 28-year-old woman, who had recently started a 4-day course of topiramate tablets 50 mg/day for a migraine, presented with reduced visual acuity bilaterally. Shallow anterior chambers, congested conjunctivae and elevated IOPs were also noted. Gonioscopy revealed closed angles. Topiramate-induced secondary angle closure was diagnosed. Topiramate was withdrawn, and timolol and mannitol were started. Visual acuity was 20/20 and other symptoms had resolved 3 days later. Author comment: "The fact that the condition resolved after stopping the suspected medication indicates a causal relationship." Senthil S, et al. Bilateral simultaneous acute angle closure caused by sulphonamide derivatives: a case series. Indian Journal of Ophthalmology 58: 248-52, No. 3, Jun 803035448 2010 - India

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Reactions 18 Sep 2010 No. 1319