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August 2002

Topiramate-Associated Secondary Angle-Closure Glaucoma: A Case Series

Arch Ophthalmol. 2002;120(8):1108. doi:10.1001/archopht.120.8.1108

We read with great interest the article by Sankar et al1 and report a case series of secondary acute angle-closure glaucoma associated with topiramate (Topamax; Ortho-McNeil Pharmaceutical, Inc, Raritan, NJ) and submitted to the Food and Drug Administration's Center for Drug and Evaluation Research Adverse Events Reporting System between April 1999 and July 2001. The case series includes 19 patients, 2 of whom were described by Sankar et al. The patients were predominantly female (89%) with a mean age of 36.5 years (age range, 5-53 years). Indications included epilepsy (n = 5), depression (n = 5), neuropathic pain (n = 2), migraine (n = 2), bipolar disorder (n = 2), weight loss (n = 1), and unknown (n = 2). When doses were reported (53% of cases), they were within the recommended range. Time to symptom onset was reported in 15 cases and typically occurred soon after starting topiramate; the mean duration of therapy before symptom onset was 10 days (range, 4 to 21 days). Symptoms included blurred vision (53%), headache (21%), transient vision loss (10%), nausea (10%), eye pain (10%), "pressure sensation" in the eyes (5%), and vomiting (5%). These symptoms resulted in hospitalization for 5 patients. Seventy-four percent of patients in whom topiramate was discontinued had improved by the time of reporting. Specific treatment for elevated intraocular pressure was described in 14 patients and included laser iridotomy (29%), medical therapy (29%), or a combination of both (42%). In 3 patients, including the 53-year-old described by Sankar et al, it was reported that iridotomy was not effective in reducing intraocular pressure; however, 2 of these 3 patients improved 2 to 14 days after discontinuation of topiramate. In 8 patients, discontinuation of topiramate coincided with medical therapy and/or iridotomy; therefore, the most effective treatment in these cases could not be determined. Recovery for the remaining patients is unknown.

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