Topiramate-induced angle-closure glaucoma: cross-sensitivity with other sulphonamide derivatives causing anterior uveitis

Abstract

Topiramate is a recognized cause of drug-induced acute angle-closure glaucoma. We describe a case presenting with bilateral acute angle-closure glaucoma caused by topiramate intake. Patient subsequently developed severe anterior uveitis caused by sulphonamide derivatives (acetazolamide and co-trimoxazole) due to cross-sensitivity, on two separate occasions. The present case also highlights the role of anterior segment optical tomography in diagnosis and follow-up. In a patient with known drug allergy to topiramate, other sulphonamide derivatives should be avoided to limit the ocular morbidity.

Topiramate-induced acute angle closure with severe panuveitis: A challenging case report

“…reported AS-OCT measurements such as angle opening distance and trabecular iris space area in the narrow angle at presentation and following treatment and discontinuation of topiramate. [ 14 ] We have documented the case with AS-OCT after 5 days of therapy. During this time, angle structures were open with fibrin exudates in the anterior chamber.…”

“…[ 13 ] The role of anterior segment optical coherence tomography (AS-OCT) in diagnosis and management of acute angle-closure glaucoma with anterior uveitis following topiramate use have been studied. [ 14 ]…”

Is uveitis associated with topiramate use? A cumulative review

“… 3 – 5 Of the three cases, only one documented a systemic uveitic workup that was negative for inflammatory or autoimmune diseases, and the patient responded to steroid therapy. 5 Two other cases 6 , 7 documented uveitis that was suggestive of cross-reactivity to sulfa-analog drugs as a proximate cause.…”

Uveitis and glaucoma

“…A comprehensive examination of the posterior segment may reveal other signs of ocular inflammation, including disc swelling, exudative retinal detachment, and choroiditis (Yang et al, 2011). Topiramate ingestion is also associated with ciliary body detachment, choroidal effusions, and anterior rotation of the ciliary processes (Etminan et al, 2012;Kamal et al, 2014;Senthil et al, 2010). Protein-bound metabolites of topiramate trigger an idiosyncratic immunological response which is independent of the drug dosage, and the inflammation resolves upon discontinuing the drug (Senthil et al, 2010).…”

“…Protein-bound metabolites of topiramate trigger an idiosyncratic immunological response which is independent of the drug dosage, and the inflammation resolves upon discontinuing the drug (Senthil et al, 2010). However, cross-reactivity with related sulphonamide derivatives, including acetazolamide, can lead to a recurrence of the inflammatory ciliary body changes and angle closure (Kamal et al, 2014).…”