Ophthalmology Unit, Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa; King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
Ophthalmology Unit, Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia.
Indian J Ophthalmol. 2022 May;70(5):1491-1501. doi: 10.4103/ijo.IJO_2134_21.
Topiramate-induced acute angle closure (TiAAC) is a potentially vision-threatening side effect of topiramate (TPM) use. The purpose of this article is to review demographic characteristics, clinical features, and management options of TiAAC. A systematic literature search of all reported cases and case series of TiAAC was conducted in the following search engines: PubMed, Web of Science, Google Scholar, Elsevier, and EBSCO. Seventy-three publications describing 77 cases were included. 58 (75.3%) patients were female, and the mean age was 34.88 ± 11.21 years (range, 7-57). The most commonly reported indication of TPM use was migraine headache (59.7%), and the mean duration from starting treatment until the onset of angle closure was 14.1 ± 31.5 days. All cases were managed by immediate cessation of TPM and topical therapy. In addition, systemic medications (carbonic anhydrase inhibitors, hyperosmotic agents, and steroids) were used in 51 patients (66.2%). A laser and/or surgical intervention was performed in 10 patients (13%). After commencement of treatment, the mean duration until the resolution of TiAAC was 3.9 ± 3.6 days (range, 1-18). The findings of our study present a summary of the current body of evidence provided by case reports and case series on TiAAC. In conclusion, the onset of angle closure following TPM use peaks at 2 weeks after initiating treatment, and in most cases, successful management can be achieved by discontinuing TPM and initiating appropriate medical therapy.
托吡酯诱导的急性闭角型青光眼（TiAAC）是托吡酯（TPM）使用的一种潜在的威胁视力的副作用。本文旨在综述 TiAAC 的人口统计学特征、临床特征和治疗选择。在以下搜索引擎中进行了关于 TiAAC 的所有报道病例和病例系列的系统文献检索：PubMed、Web of Science、Google Scholar、Elsevier 和 EBSCO。共纳入了 73 篇描述 77 例病例的文献。58 例（75.3%）患者为女性，平均年龄为 34.88±11.21 岁（范围：7-57 岁）。TPM 最常见的应用指征是偏头痛（59.7%），从开始治疗到闭角发生的平均时间为 14.1±31.5 天。所有病例均通过立即停止 TPM 和局部治疗进行管理。此外，51 例患者（66.2%）使用了全身药物（碳酸酐酶抑制剂、高渗剂和类固醇）。10 例患者（13%）进行了激光和/或手术干预。开始治疗后，TiAAC 缓解的平均时间为 3.9±3.6 天（范围：1-18 天）。本研究的结果总结了病例报告和病例系列提供的当前关于 TiAAC 的证据。总之，TPM 治疗开始后 2 周达到闭角发生的高峰，在大多数情况下，通过停止 TPM 和开始适当的药物治疗可以实现成功的管理。
