Gualtieri William, Janula Jan
Surgical Vitreoretinal Unit, Department of Ophthalmology, Mater Dei University Hospital, Msida, Malta.
Int Ophthalmol. 2013 Feb;33(1):103-6. doi: 10.1007/s10792-012-9640-3. Epub 2012 Sep 28.
The purpose of this study is to present the first case of a pure 'topiramate maculopathy' without acute glaucoma and/or myopia, which form the classical syndrome.
Interventional/observational case report.
Institutional University Teaching Hospital.
A 22-year-old American female, after taking 100 mg of topiramate (Topamax®) a day for 6 days because of a migraine attack, complained of severe visual acuity deterioration of sudden onset in both eyes, regardless of distance (far or near), during the span of 1 day. A complete ocular examination was carried out. Best-corrected visual acuity (BCVA) in the right eye was hand motion and in the left eye was counting fingers. Cycloplegic refraction and pinhole did not improve the visual acuity of patient's eyes. The anterior chamber depth was normal in both eyes. Tonometry was 14 mmHg in both eyes. Fundus biomicroscopy disclosed a maculopathy with macular striae and a cellophane-like reflex. Optical coherence tomography (OCT) showed an undulating profile with congruent retinal folds and choroidal layers plicae. INTERVENTIONAL/OBSERVATION PROCEDURE: Immediate discontinuation of Topamax and steroid therapy.
BCVA, cycloplegic refraction, tonometry, fundus photography, and OCT. Three days after suspension of Topomax and steroid therapy the patient's BCVA was 6/6 in both eyes. Tonometry was 14 mmHg in both eyes. Fundus appearance and OCT features were nearly normal. After 2 years of follow-up, the patient's BCVA, tonometry, macula, and OCT are stable in both eyes. In conclusion, an isolated (unassociated with glaucoma and/or induced myopia) acute maculopathy, previously known as being part of a rare syndrome, has been identified, described, and documented.
本研究的目的是报告首例无急性青光眼和/或近视的单纯“托吡酯黄斑病变”病例，急性青光眼和/或近视构成经典综合征。
干预性/观察性病例报告。
大学教学附属医院。
一名22岁美国女性，因偏头痛发作，连续6天每天服用100毫克托吡酯（妥泰®），在1天内双眼突然出现严重视力下降，无论看远或看近。进行了全面的眼部检查。右眼最佳矫正视力（BCVA）为手动，左眼为指数。睫状肌麻痹验光和针孔镜检查均未提高患者的视力。双眼前房深度正常。双眼眼压为14 mmHg。眼底生物显微镜检查发现黄斑病变，有黄斑条纹和玻璃纸样反光。光学相干断层扫描（OCT）显示有起伏的轮廓，伴有一致的视网膜褶皱和脉络膜层褶皱。
干预性/观察性操作：立即停用妥泰并进行类固醇治疗。
BCVA、睫状肌麻痹验光、眼压测量、眼底照相和OCT。停用妥泰和类固醇治疗3天后，患者双眼BCVA均为6/6。双眼眼压为14 mmHg。眼底外观和OCT特征几乎正常。经过2年随访，患者双眼的BCVA、眼压、黄斑和OCT均稳定。总之，已识别、描述并记录了一种孤立的（与青光眼和/或诱发近视无关）急性黄斑病变，该病变以前被认为是一种罕见综合征的一部分。
