Topiramate-induced acute angle closure: A systematic review of case reports and case series

Abstract

Topiramate-induced acute angle closure (TiAAC) is a potentially vision-threatening side effect of topiramate (TPM) use. The purpose of this article is to review demographic characteristics, clinical features, and management options of TiAAC. A systematic literature search of all reported cases and case series of TiAAC was conducted in the following search engines: PubMed, Web of Science, Google Scholar, Elsevier, and EBSCO. Seventy-three publications describing 77 cases were included. 58 (75.3%) patients were female, and the mean age was 34.88 ± 11.21 years (range, 7–57). The most commonly reported indication of TPM use was migraine headache (59.7%), and the mean duration from starting treatment until the onset of angle closure was 14.1 ± 31.5 days. All cases were managed by immediate cessation of TPM and topical therapy. In addition, systemic medications (carbonic anhydrase inhibitors, hyperosmotic agents, and steroids) were used in 51 patients (66.2%). A laser and/or surgical intervention was performed in 10 patients (13%). After commencement of treatment, the mean duration until the resolution of TiAAC was 3.9 ± 3.6 days (range, 1–18). The findings of our study present a summary of the current body of evidence provided by case reports and case series on TiAAC. In conclusion, the onset of angle closure following TPM use peaks at 2 weeks after initiating treatment, and in most cases, successful management can be achieved by discontinuing TPM and initiating appropriate medical therapy.

You Shall Not Turn a Blind Eye to Intraocular Pressure

“…Anticholinergic and adrenergic agents cause mydriasis, iridocorneal angle closure, and pupillary block by different mechanisms, the first by muscarinic-receptor antagonism on the iris sphincter muscle and the second by stimulation of α 1 -receptors on the iris dilatator muscle 11 . Although cholinergic agents' action on the iris constriction muscle muscarinic receptors causes miosis and pulls the iris away from the TM, they lead to contraction of ciliary muscles, loosening of the zonules, lens rounding, and a forward displacement of the lens into the anterior chamber and may worsen iridocorneal angle obstruction 11 …”