Anterior Angle Closure Glaucoma Induced by Topiramate and Follow Up by Anterior Chamber Angle Optical Coherence Tomography - A Case Report

Abstract

We describe a case of a 26 year old female who developed bilateral angle closure glaucoma associated with oral topiramate therapy and her follow up by Anterior Chamber Angle Optical Coherence Tomography (ACA-OCT) during her treatment. We observed a partial resolution of symptoms and corneal edema after cessation of topiramate and initiation of topical and oral antiglaucomatose drugs, but, an anatomic resolution determined by the aperture of the anterior chamber angle by ACA-OCT was only visualized after topical cycloplegic drugs were started. Intraocular pressure normalized during the first week after the therapy started, aperture of the anterior chamber angle was observed 1 day after cycloplegic drugs therapy started, visual acuity normalized 20 day after the cessation of topiramate and two weeks after the cessation of topical atropine. Topiramate, a sulfa-derivative antiepileptic medication may cause idiosyncratic ciliochoroidal detachments and ciliary body edema leading to anterior displacement of the lens-iris diaphragm, lens thickening, and acute angle-closure glaucoma. The clinical history is important for the identification of this pathology in order to start the treatment based in cessation of the oral topiramate, antiglaucomatose drugs and topical atropine. Figure 1: Shows the temporal ACA-OCT in right eye (RE) and left eye (LE) at the beginning of the Bilateral TPM induced AACG (I), 24 hours after antiglaucomatose therapy and cessation of topiramate (II) and 24 hours after beginning of topical atropine therapy (III). Citation: Limo SAA, Limo CEA (2019) Anterior Angle Closure Glaucoma Induced by Topiramate and Follow Up by Anterior Chamber Angle Optical Coherence Tomography A Case Report. J Ophthalmic Clin Res 6: 058.