Topiramate
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Topiramate Bilateral acute angle closure and unilateral cataract: case report
An 18-year-old woman developed cataract in the right eye following bilateral secondary acute angle closure during treatment with topiramate for headache. The woman presented with a diagnosis of bilateral acute angle closure (diagnosed at another healthcare facility), and she had been treated with pilocarpine, unspecified antiglaucoma medications, β-blocker and prostaglandin analogue. At presentation, she had photophobia, excessive watering, sudden diminution of vision and pain. She reported that she had been receiving topiramate [route not stated] 25mg twice daily for 10 days for headache. At the current presentation, she had a visual acuity of counting fingers 2 feet in the right eye (OD) and counting fingers 4 feet in the left eye (OS). Her eyelids were swollen. Slit lamp examination revealed diffuse stromal haze (OD > OS), mild chemosis, ciliary flush, microcystic corneal oedema OS, and very shallow peripheral anterior chamber with areas of iridocorneal touch (OD > OS). The pupil was semidilated and sluggishly reacting without rapid afferent pupillary defect. She had intraocular pressure of 40mm Hg in the right eye and 32mm Hg in the left eye. A presumptive diagnosis of topiramate-induced bilateral secondary acute angle closure attack was made [time to reaction onset not stated]. The treatment with topiramate was discontinued. The woman was treated with mannitol, acetazolamide, dorzolamide, timolol, brimonidine, homatropine and dexamethasone. At follow-up after 1 day, the cornea appeared clearer in both eyes, and the right eye had peripheral anterior capsular lenticular opacity. The vitreous was clear and no aqueous flair was observed. Fundus examination revealed normal optic disc, macula and retina. Her intraocular pressure was found to be decreased to 12mm Hg (OD) and 10mm Hg (OS). Closed angles were observed with gonioscopy. Anterior segment optical coherence tomography (ASOCT) revealed forward movement of the iris-lens diaphragm with closed angles. B-scan of right eye showed ciliochoroidal effusion, and B-scan of the left eye was normal. At 1-week follow-up, ASOCT revealed that the iris-lens diaphragm was moved back with open angle. One week after the presentation, all cycloplegic and antiglaucoma drugs were stopped and she continued to receive unspecified steroid for one week. At 2-month follow-up, the left eye did not show any lenticular changes, and the right eye showed increased density of cataract and formed anterior chamber. A definite progression of cataract in the right eye from 1 day to 2 months was confirmed, and cataract surgery was advised. Kate T, et al. A Rare Case of Unilateral Progressive Cataract in a Young Patient Receiving Topiramate. Case Reports in Ophthalmology : 276-281, Jan 2020
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Reactions 5 Sep 2020 No. 1820
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