Acute bilateral angle-closure glaucoma induced by topiramate: Contribution of Visante® OCT

Introduction. - Topiramate, a sulfamate-substituted monosaccharide classically used as an antiepileptic medication, has been widely used since its recent indication for migraine prophylaxis. We report the case of a 68-year-old woman who developed bilateral acute glaucoma following topiramate migraine prophylaxis. Observation. - A 68-year-old woman presented in the emergency department for ocular pain, redness, and bilateral reduced visual acuity associated with nausea and vomiting. Initial examination found a bilateral corneal edema with shallow anterior chambers and closed iridocorneal angles. Intraocular pressure was 40 mmHg in the right eye and 45 mmHg in the left eye. Ultrasound biomicroscopy diagnosed ciliochoroidal detachment and swollen ciliary processes with closed angles, which was also objectified using the Visante (R) OCT. Topiramate treatment was interrupted and a local and general hypotonic treatment was started. After 4 days, examination showed deeper anterior chambers and normal intraocular pressures. Visante (R) OCT and ocular echography follow-up examinations were normal, and Indoramin was prescribed for migraine prophylaxis with no relapse after 10 months. Conclusion. - Bilateral acute angle-closure glaucoma is a possible complication of topiramate. Physicians and patients starting this therapy should be aware of this underestimated risk. (C) 2010 Elsevier Masson SAS. All rights reserved.