Topiramate and asymptomatic ocular angle narrowing: a prospective pilot study

Abstract

Purpose To investigate whether subclinical ciliochoroidal effusion and resulting asymptomatic angle narrowing occurs in patients taking topiramate, by ultrasound biomicroscopy (UBM). Methods Chinese patients aged 18-75 years for whom topiramate was indicated were recruited. Examinations including UBM were performed before and 4 weeks after commencement of topiramate. Results In this pilot of 20 eyes of 20 patients, there were no statistically significant changes in the angle parameters noted on gonioscopy or UBM, including anterior chamber depth, angle-opening distance at 500 lm, trabecular ciliary process distance, trabecular-iris angle, and scleral thickness. Conclusion Short-term use of topiramate does not induce asymptomatic angle narrowing.

Topiramate and the vision: a systematic review

“…Among 74 included studies: (a) two studies were carried out using general health organizations’ documents (eg, World Health Organization),23,24 (b) two were prospective cohort studies concerning the adverse ophthalmic effects of TPM,25,26 (c) three were experimental studies concerning possible positive/negative effects of TPM on vision,27–29(d) two were case reports describing the possible beneficial effects of TPM on vision,30,31 and (e) 65 were small observational studies that described the ophthalmic side effects of TPM in consumers 32–96…”

“…It is important for physicians to warn their patients about this issue during these critical periods. Despite the possible idiosyncratic nature of TPM side effects, further prospective studies similar to those carried out by Ozturk et al25 and Leung et al26 but with a longer follow-up duration, are needed to elucidate dose-dependent ocular manifestations.…”

“…In 2009, Leung et al26 published the results of the first prospective study evaluating the ophthalmic complications of TPM. They studied the effects of short-term (4 weeks) TPM administration on angle narrowing in 20 Chinese patients aged 18–75 years using ultrasound biomicroscopy.…”

“…This imaging technique can provide a detailed evaluation of angle parameters and detect evidence of ciliochoroidal effusion 26,40,41,53–56,68,81,84. B-scan ultrasonography helps to detect posterior choroidal detachment which is usually shallow,34,42,46,51–54,66,69,89 but may sometimes be large and extend to the posterior pole 92…”

Non-steroidal drug-induced glaucoma

“…Glaucoma occurred between days 1 and 49, after drug initiation, with an average of 7 days. In a pilot study by Leung et al, 77 it was shown that short-term use of topiramate did not induce asymptomatic angle narrowing. Therefore, it was suggested that topiramateinduced secondary CAG may be an all-or-none phenomenon.…”