Topiramate
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Topiramate Bilateral acute angle closure, myopia and ciliochoroidal effusion: 6 case reports
In a case series of 6 women aged 25–48 years, who presented between January 2018 and December 2019, developed bilateral acute angle closure, myopia or ciliochoroidal effusion during treatment with topiramate for headache [routes not stated]. The women presented to the emergency department with sudden onset diminution of vision and mild pain in eyes for 48 hours (4 women), and two women presented after 48 hours of symptoms onset. The women had been receiving topiramate tablet 25mg per day for 7–10 days for headache. On examination, the women had poor vision ranging from 1/60–6/60 to counting fingers close to the face in both eyes. Spherical refraction revealed moderate to large myopia of -1.5 to -8 dioptres except in one woman, who revealed slight hyperopic shift. Ocular examination revealed edematousa cornea because of bilateral shallow anterior chamber. The intraocular pressure was 14–62mm Hg, except in those women who were receiving unspecified anti-glaucoma medications. Gonioscopy revealed a closed pathways in both eyes which was confirmed with anterior segment optical coherence tomography. Fundus examination revealed a normal macula and disc except in one woman. Ultrasound B scan revealed thickened retinochoroido-scleral complex and choroidal detachments suggestive of ciliochoroidal effusion. The woman, who did not show normal macula and disc, had thickened peripapillary choroid, and hypermetropia due to disc oedema in both eyes. A diagnosis of bilateral acute angle closure was made. The women’s treatment with topiramate was discontinued. The women received treatment with dexamethasone/prednisolone, timolol [timolol maleate], brimonidine, dorzolamide, mannitol, glycerol, nepafenac, dexamethasone or prednisolone. The intraocular pressure had decreased, the cornea cleared, vision improved, the myopic shift resolved and the anterior chamber deepened within 4–10 days in 4 women. The previously closed angles opened up, which was confirmed with anterior segment optical coherence tomography and Gonioscopy in 4 women. The choroidal effusion recovered. However, the two women, who presented later than 48 hours revealed permanent structural damage. Gopalakrishna M, et al. A case series of topiramate-induced angle closure crisis - an ophthalmic emergency. Cephalalgia : 2020. Available from: URL: http:// doi.org/10.1177/0333102420946736
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Reactions 12 Sep 2020 No. 1821
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