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Anterior segment optical coherence tomography in angle closure glauma with topiramat use

Shubhakaran, Khichar Purnaram

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doi: 10.4103/0301-4738.149155
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Dear Sir,

I read an interesting case report entitled “anterior segment optical coherence tomography documentation of a case of topiramate induced acute angle closure” by Mitra et al. in May 2014 issue of the journal.[1] It was an interesting and excellent documentation where besides other investigations the diagnostic help of optic coherence tomography (OCT) was taken, which probably is the first Indian documentation. Here, I would like to share my views and experience.

  • Topiramate is used as a USFDA approved (1996) important add on therapy in various neuro-psychiatric conditions. Myopia and acute angle-closure glaucoma are being infrequently described since 2001,[2] after which the USFDA has issued warning
  • Early diagnosis and treatment are crucial to prevent blindness which, of course, depends on techniques applied. OCT has many advantages over genioscopy and other procedures.[3] Hence, the OCT can be used for mass screening
  • I am frequently using this drug in patients of headache and epilepsy, and till now have used in about thousands of patient. Of course, the dose is not an important factor, I came across only one such complication with this drug at a very low dose of 12.5 mg that is not described previously. After investigations the diagnosis of angle closure glaucoma was considered, and the patient recovered completely and early after the topiramate was withdrawn
  • Topiramate is being used either alone or in combination as an antiepileptic, for treatment of headache, depression, bipolar disorders, neuropathic pain, posttraumatic stress disorders, postherpetic neuralgia and alcohol and nicotine abstinence.[4] It has an excellent profile when a patient is obese or gaining weight because of other drugs at which time it can be added upon, and such combinations are worth importance. Among it's important side-effects are renal stones formation and rare, but not least the angle closure glaucoma. There is a slight increase in the risk of glaucoma among elderly users of topiramate, and this risk is further elevated among new users of the drug. So we should be careful, whereas prescribing this drug about this reversible complication. If the facilities are available we can screen the patient with OCT who has the predisposing anatomy of the anterior eye chamber like shallow anterior chamber
  • Looking into widespread use of topiramate OCT is an important tool to avoid the complication of angle closure glaucoma and subsequent blindness if not recognized well on time.
1. Mitra A, Ramakrishnan R, Kader MA. Anterior segment optical coherence tomography documentation of a case of topiramate induced acute angle closure Indian J Ophthalmol. 2014;62:619–22
2. Banta JT, Hoffman K, Budenz DL, Ceballos E, Greenfield DS. Presumed topiramate-induced bilateral acute angle-closure glaucoma Am J Ophthalmol. 2001;132:112–4
3. Lin S, Huang JY. Applications of anterior segment optical coherence tomography for angle-closure related diseases Taiwan J Ophthalmol. 2012;2:77–80
4. Aminlari A, East M, Wei W, Quillen D. Topiramate induced acute angle closure glaucoma Open Ophthalmol J. 2008;2:46–7
© 2014 Indian Journal of Ophthalmology | Published by Wolters Kluwer – Medknow