No abstract

BackgroundWe report a case of peripheral pigmentary retinopathy and visual field loss following topiramate use for uncontrolled seizures. Such side effects have not been well documented despite the increasing use of topiramate in the past 10 years. A thorough search of available English literature revealed only a small number of reports of topiramate-induced retinopathy or visual field defects in humans. One similar case has been described. We are concerned about the possible rare instances of this occurrence in future patients and hence would like to propose a presumed correlation.Case presentationA 48-year-old Chinese woman developed blurred vision after 9 months of topiramate use. Her visual acuity dropped from 1.2 to 0.7 in both eyes, with bilateral diffuse pigmentary retinopathy and a constricted visual field. Despite an improvement in visual acuity after cessation of the drug, the other clinical findings remained. The temporal relationship between the initiation of topiramate and the visual disturbance suggests that topiramate could be the cause of such signs and symptoms.ConclusionTopiramate potentially causes pigmentary retinopathy and constricted visual field.

To date, there remain many unknowns regarding ocular involvement in COVID-19. Various studies have reported conflicting rates of conjunctival carriage of SARS-CoV-2 (Table 1). A cross-sectional study on 1099 patients in China found only 0.8% of COVID-19 patients developed conjunctival congestion, 1 whereas a recent meta-analysis found the pooled prevalence of ocular manifestations among COVID-19 patients was 5.5% and the sensitivity of detecting SARS-CoV-2 in ocular fluids was merely 0.6%. 2 The low detection rate may suggest a low incidence of viral infiltration into ocular surface or may be due to variations in sampling technique, sampling time window, and underrepresentation from critical cases. To provide an answer, we set out to standardize the sampling technique and sampling time to minimize the chance of false negative results and to gauge whether SARS-CoV-2 can really infect the ocular surface.