Center for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Canada.
Am J Ophthalmol. 2012 May;153(5):827-30. doi: 10.1016/j.ajo.2011.10.018. Epub 2012 Jan 20.
To examine the possible link of acute-onset glaucoma with topiramate.
Case-control study.
A case-control study was conducted among a cohort of subjects who had visited an ophthalmologist in the Province of British Columbia, Canada from 2000 to 2007. Cases were identified as those newly diagnosed with glaucoma (ICD-9 360). For each case, 5 controls were selected and matched to the cases by age and calendar time using density-based sampling. Crude and adjusted rate ratios (RRs) for current and past use of topiramate were computed. As a sensitivity analysis, the risk of glaucoma with a positive control drug (an oral steroid) and a negative control drug (inhaled albuterol) was also assessed.
From the initial cohort of 989 591 subjects, 178 264 cases of glaucoma and 891 320 controls were identified. There was a slight increase in the risk of glaucoma among current users of topiramate (RR = 1.23 [95% confidence interval (CI), 1.09-1.40]). This risk was further elevated among new users of the drug (RR = 1.54 [95% CI, 1.09-2.17]). No increase in the risk of glaucoma requiring drug therapy was observed among current topiramate users (RR = 1.09 [95% CI, 0.80-1.61]).
We found an increase in the risk of glaucoma with first-time users of topiramate. Future studies are needed to confirm these findings.
探讨托吡酯与急性闭角型青光眼之间可能存在的联系。
病例对照研究。
本病例对照研究纳入了 2000 年至 2007 年期间在加拿大不列颠哥伦比亚省看眼科医生的队列人群。病例是指新诊断为青光眼的患者（ICD-9 360）。每例病例匹配 5 名年龄和日历时间相匹配的对照。计算了托吡酯目前和过去使用的粗率比（RR）和调整 RR。作为敏感性分析，还评估了阳性对照药物（口服类固醇）和阴性对照药物（吸入沙丁胺醇）的致青光眼风险。
在最初的 989591 名受试者中，确定了 178264 例青光眼病例和 891320 例对照。托吡酯的当前使用者患青光眼的风险略有增加（RR=1.23[95%置信区间（CI），1.09-1.40]）。新使用者的风险进一步升高（RR=1.54[95% CI，1.09-2.17]）。在当前托吡酯使用者中，需要药物治疗的青光眼风险没有增加（RR=1.09[95% CI，0.80-1.61]）。
我们发现首次使用托吡酯与青光眼风险增加有关。需要进一步的研究来证实这些发现。
