RESUMO
PURPOSE: We describe a case of bilateral angle-closure glaucoma associated with oral topiramate therapy. METHODS: Interventional case report. Case report with echographic illustration. RESULTS: A 51-year-old man developed bilateral acute angle-closure glaucoma 2 weeks after beginning topiramate therapy for bipolar affective disorder. Laser peripheral iridotomy was performed in the right eye without resolution of the acute attack. Echography revealed lens thickening and ciliochoroidal detachments in both eyes. Visual acuity, intraocular pressure, and anterior and posterior segment anatomy normalized 2 weeks after cessation of topiramate therapy. CONCLUSION: Topiramate, a new sulfa-derivative antiepileptic medication, may cause idiosyncratic ciliochoroidal detachments and ciliary body edema leading to anterior displacement of the lens-iris diaphragm, lens thickening, and acute angle-closure glaucoma.
Assuntos
Anticonvulsivantes/efeitos adversos , Frutose/efeitos adversos , Glaucoma de Ângulo Fechado/induzido quimicamente , Doença Aguda , Administração Oral , Transtorno Bipolar/tratamento farmacológico , Doenças da Coroide/induzido quimicamente , Doenças da Coroide/diagnóstico por imagem , Frutose/análogos & derivados , Glaucoma de Ângulo Fechado/diagnóstico , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Topiramato , Ultrassonografia , Acuidade VisualRESUMO
OBJECTIVE: To determine the efficacy and safety of optic nerve sheath decompression in a large population of patients with pseudotumor cerebri with visual loss despite medical treatment and to suggest a treatment algorithm on the basis of these data. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: One hundred fifty-eight eyes in 86 patients with pseudotumor cerebri. INTERVENTION: Optic nerve sheath decompression. MAIN OUTCOME MEASURES: Visual acuity, visual fields, and surgical complications. RESULTS: After optic nerve sheath decompression for pseudotumor cerebri, visual acuity stabilized or improved in 148 of 158 (94%) eyes, and visual fields stabilized or improved in 71 of 81 (88%) eyes. Surgical complications, most of which were transient and benign, were seen in 39 of 86 patients. Only one eye in one patient had permanent severe visual loss secondary to an operative complication. CONCLUSIONS: In patients with pseudotumor cerebri with progressive visual loss despite maximum medical therapy, optic nerve sheath decompression is a safe and effective means of stabilizing visual acuity and the visual fields of those tested.
