Bilateral Angle Closure Following Use of a Weight Loss Combination Agent Containing Topiramate

Grewal, Dilraj S.; Goldstein, Debra A.; Khatana, Anup K.; Tanna, Angelo P.

doi:10.1097/ijg.0000000000000157

Cited by 23 publications

(14 citation statements)

References 19 publications

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“…Cholinergic agents also cause contraction of the ciliary muscles, which leads to looser zonules, lens rounding, and forward displacement of the lens into the anterior chamber. 30 In topiramate-induced AACG, pilocarpine can stimulate further anterior displacement of the lens-iris diaphragm and worsen the iridocorneal angle obstruction 31,32 (Table 1).…”

Section: Cholinergic Agentsmentioning

confidence: 99%

“…Angle closure typically occurs within 2 weeks of starting topiramate, but reports have ranged between 1 days and 262 days. 31 The proposed mechanism is ciliary detachment and ciliary body edema, which causes relaxation of the zonules and thickening of the lens. As the lens enlarges, the lens-iris diaphragm is displaced anteriorly, and the anterior chamber becomes more shallow and increasingly susceptible to angle closure.…”

Section: Sulfonamides (Topiramate)mentioning

confidence: 99%

“…In addition, cholinergic agents may actually worsen the angle closure by inducing further anterior rotation of the lens-iris diaphragm and exacerbate preexisting intraocular inflammation. 31,32 It is important to note that in clinical encounters, a history of topiramate use may not be elicited or reliable, and that LPI should be performed when topical medications fail to break the angle closure. In other words, the pupillary block mechanism should always be ruled out first by performing LPI.…”

Section: Sulfonamides (Topiramate)mentioning

confidence: 99%

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Drug-induced Acute Angle-closure Glaucoma: A Review

Yang

Lin

2019

Journal of Current Glaucoma Practice

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Aim: Our goal is to review current literature regarding drug-induced acute angle-closure glaucoma (AACG) and provide ophthalmologists and general practitioners with a thorough understanding of inciting medications and treatment pitfalls to be avoided. Background: Drug-induced AACG is an ophthalmological emergency that ophthalmologists and general practitioners should be familiar with, given its potentially blinding consequences. Common anatomical risk factors for AACG include a shallow anterior chamber depth, short axial length, plateau iris configuration, thick lens, anteriorly positioned lens, and rarely, intraocular tumor. Demographic risk factors include female sex, Asian ethnicity, family history, and advanced age. In patients with predisposing factors, acute angle closure can be triggered by various classes of medications including adrenergic agonists, anticholinergics, cholinergics, sulfonamides, supplements, and serotonergic medications. Physicians prescribing such inciting medications should be aware of their potentially sight-threatening adverse effects and to inform patients of the warning symptoms. Patients typically present with elevated intraocular pressure (IOP), headache, nausea, blurry vision, and halos around lights. Review results: There are two main mechanisms of drug-induced AACG, both with different treatment strategies. The first mechanism of druginduced AACG is pupillary block and iridocorneal angle closure secondary to thickening of iris base with mydriasis. The second mechanism of drug-induced AACG is anterior displacement of the lens-iris diaphragm due to mass effect (e.g., blood, misdirected aqueous humor, and tumors), uveal effusion, or weakened zonules. Conclusion:This paper reviews drug-induced AACG, high-risk anatomical features, underlying mechanisms, inciting medications, and options for treatment and prevention. Clinical significance: With proper understanding of the underlying mechanism of drug-induced AACG, physicians can respond promptly to save their patients' vision by employing the correct treatment strategy.

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Section: Cholinergic Agentsmentioning

confidence: 99%

Section: Sulfonamides (Topiramate)mentioning

confidence: 99%

Section: Sulfonamides (Topiramate)mentioning

confidence: 99%

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Drug-induced Acute Angle-closure Glaucoma: A Review

Yang

Lin

2019

Journal of Current Glaucoma Practice

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“…described one case with similar attack of bilateral angle closure glaucoma after using combination agent containing topiramate for weight loss for 1-week duration with complete recovery after medical treatment. [ 6 ] Moreover, Senthil et al . published a case series in which one of the cases had 4 days duration of topiramate usage.…”

Section: Discussionmentioning

confidence: 99%

Topiramate-induced angle closure glaucoma

Alzendi

Badawi

Alhazzaa

et al. 2020

Saudi Journal of Ophthalmology

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The aim of this study is to report the side effects of oral topiramate in two young patients presented with bilateral ocular blurring and discomfort, causing unique development of secondary acute angle closure (AAC) after discontinuation of oral topiramate. Both patients, with a history of seizure and migraine, respectively, were taking oral topiramate to control their mentioned diseases. Both had secondary AAC and high intraocular pressure, after discontinuing topiramate. They were treated with topical medications and underwent initial and subsequent multimodal imaging to track up their response to the management. Ocular side effect, during topiramate use and possibly even after discontinuation, will improve early detection of secondary AAC. Topical management along with multimodal imaging of such cases can give optimal results.

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“…First, young patients diagnosed with AACG might have plateau iris syndrome, which is often treated with argon laser peripheral iridoplasty or pilocarpine. Second, younger AACG patients could be associated with the use of drugs such as topiramate, which is approved as an anti-convulsant for treatment of seizure disorders and for prevention of migraine headaches, and, however, is commonly used in obesity therapeutics 21222324. Those drugs are known to cause secondary angle closure, and treated with medications.…”

Section: Discussionmentioning

confidence: 99%

Nationwide Incidence of Acute Angle Closure Glaucoma in Korea from 2011 to 2015

Park

Kim

et al. 2019

J Korean Med Sci

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BackgroundDespite the significant disease burden, there is a paucity of data addressing the population-based incidence of acute angle closure glaucoma (AACG). Therefore, we estimated the nationwide, population-based standardized incidence rate of AACG in Korea.MethodsWe conducted a nationwide, population-based, retrospective study using the database of National Health Insurance (NHI) system, which includes the entire Korean population (approximately 50 million people) from 2009 to 2015. We identified patients with incident AACG during the 5-year study period from 2011 to 2015 based on their diagnosis and AACG-related treatments (laser iridotomy and cataract surgery), and estimated age- and gender-standardized incidence rate of AACG during the study period.ResultsWe identified 11,049 patients (8,022 women, 72.6%) with incident AACG during the 5-year study period. Of these, after excluding 6 patients under 20 years old, 11,043 patients (8,020 women, 72.6%) aged ≥ 20 years were included in the analysis. The average standardized incidence rate during the 5-year study period was 59.95 (95% confidence interval [CI], 58.87–61.03) per 1,000,000 person-years. The incidence rates increased sharply with age and peaked at individuals aged 75–79 years; in men, those peaked at the same age group, however, in women, those peaked at individuals aged 70–74 years. Women has a 2.56 folds higher incidence rate (85.84 [95% CI, 84.03–87.66] per 1,000,000 person-years) than men (33.48 [95% CI, 32.33–34.62] per 1,000,000 person-years).ConclusionThe present study provides detailed estimates for AACG incidence according to all age groups and gender through the 5-year study period.

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Bilateral Angle Closure Following Use of a Weight Loss Combination Agent Containing Topiramate

Abstract: Bilateral acute angle closure may develop after ingestion of weight loss drugs containing topiramate.

Cited by 23 publications

References 19 publications

Drug-induced Acute Angle-closure Glaucoma: A Review

Drug-induced Acute Angle-closure Glaucoma: A Review

Topiramate-induced angle closure glaucoma

Nationwide Incidence of Acute Angle Closure Glaucoma in Korea from 2011 to 2015

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