Efficiency of Choroidal Thickness Monitoring to Prevent Topiramate Induced Acute Angle Closure Glaucoma

Selcuk Kara, Muammer Ozcimen, Hacer Doganay Aydin, Yasar Sakarya, Baran Gencer, Hasan Ali Tufan, Sedat Arikan
1.083 499


The aim of this study is to investigate early findings of the choroidal effusion induced by topiramate use which is thought to be responsible for bilateral acute angle closure glaucoma. Enhanced depth imaging (EDİ) spectral domain optical coherence tomography (SD-OCT) recordings of 34 patients who has been used topiramate for the prophylaxis of migraines, before and after 2 weeks of drug use were retrospectively investigated. Alterations in subfoveal choroidal layer thicknesses and peripapillary retinal nerve fiber layer (RNFL) thickness were measured manually by two masked observers. The mean measurements of subfoveal choroidal layer thickness were 315.67±80.98 µm before use of the drug and 314.89±76.40 µm in 2nd week of drug use. However, this slight decrease was not statistically significant. The mean peripapillary RNFL thickness was 104.47±10.48 µm before use of the drug, and significant thinning was found only in the temporal quadrant during follow-up after use of the drug (p=0.008). No subclinical subfoveal choroidal effusions were encountered using EDİ SD-OCT in patients after 2 weeks of topiramate use. Further studies are needed to find out the cause of bilateral ciliochoroidal effusion related with topiramate use.


Choroidal effusion, topiramate, acute angle closure glaucoma, optical coherence tomography

Full Text:



United States Food and Drug Administration; Ortho- McNeil Pharma- ceutical Inc. FDA approved labeling text. 2011. Available from: http://www.accessdata.fda.gov/ drugsatfda_docs/label/2011/020505s040s045,020844s035 s037lbl.pdf. Accessed August 27, 2012.

Abtahi MA, Abtahi SH, Fazel F et al. Topiramate and the vi- sion: a systematic review. Clin Ophthalmol 2012;6:117-31.

Fraunfelder FW, Fraunfelder FT, Keates EU. Topiramate- associated acute, bilateral, secondary angle-closure glau- coma. Ophthalmology 2004;111:109-11.

Natesh S, Rajashekhara SK, Rao AS, Shetty B. Topiramate- induced angle closure with acute myopia, macular striae. Oman J Ophthalmol 2010;3(1):26-8.

Aminlari A, East M, Wei W, Quillen D. Topiramate in- duced acute angle closure glaucoma. Open Ophthalmol J 2008;2:46-7.

Craig JE, Ong TJ, Louis DL, Wells JM. Mechanism of topi- ramate-induced acute-onset myopia and angle closure glaucoma. Am J Ophthalmol 2004;137(1):193-5.

Van Issum C, Mavrakanas N, Schutz JS, Shaarawy T. Topiramate-induced acute bilateral angle closure and myopia: pathophysiology and treatment controversies. Eur J Ophthalmol 2011;21(4):404-9.

Leung DY, Leung H, Baig N et al. Topiramate and asymp- tomatic ocular angle narrowing: a prospective pilot study. Eye (Lond) 2009;23(11):2079-81.

Ozturk BT, Genc E, Tokgoz M, Kerimoglu H, Genc BO. Ocular changes associated with topiramate. Curr Eye Res 2011;36(1):47-52.

Malhotra A, Minja FJ, Crum A, Burrowes D. Ocular anatomy and cross-sectional imaging of the eye. Semin Ultrasound CT MR 2011;32:2–13.

Regatieri CV, Branchini L, Fujimoto JG, Duker JS. Choroidal imaging using spectral-domain optical coher- ence tomography. Retina 2012;32(5):865-76.

Kotowski J, Wollstein G, Folio LS, Ishikawa H, Schuman JS. Clinical use of OCT in assessing glaucoma progression. Ophthalmic Surg Lasers Imaging 2011;42:6-14.

Spaide RF, Koizumi H, Pozzoni MC. Enhanced depth imag- ing spectral-domain optical coherence tomography. Am J Ophthalmol 2008;146(4):496-500.

Gemenetzi M, De Salvo G, Lotery AJ. Central serous cho- rioretinopathy: an update on pathogenesis and treat- ment. Eye (Lond) 2010;24:1743–56.

Koizumi H, Yamagishi T, Yamazaki T, Kawasaki R, Kinoshita S. Subfoveal choroidal thickness in typical age-related macular degeneration and polypoidal cho- roidal vasculopathy. Graefes Arch Clin Exp Ophthalmol 2011;249(8):1123-8.

Torres VL, Brugnoni N, Kaiser PK, Singh AD. Optical coher- ence tomography enhanced depth imaging of choroidal tumors. Am J Ophthalmol 2011;151:586–93.

Supuran CT, Di Fiore A, De Simone G. Carbonic anhydrase inhibitors as emerging drugs for the treatment of obesity. Expert Opin Emerg Drugs 2008;13(2):383-92.

Mula M, Cavanna AE, Monaco F. Psychopharmacology of topiramate: from epilepsy to bipolar disorder. Neuropsychiatr Dis Treat 2006;2(4):475-88.

Johnson BA, Ait-Daoud N. Topiramate in the new genera- tion of drugs: efficacy in the treatment of alcoholic pa- tients. Curr Pharm Des 2010;16(19):2103-12.

Gualtieri W, Janula J. Topiramate maculopathy. Int Ophthalmol 2013;33(1):103-6.

Spaccapelo L, Leschiutta S, Aurea C, Ferrari A. Topiramate- associated acute glaucoma in a migraine patient receiving concomitant citalopram therapy: a case-report. Cases J 2009;2(1):87.

Wiśniewski M, Łukasik-Głebocka M, Anand JS. Acute topi- ramate overdose--clinical manifestations. Clin Toxicol (Phila) 2009;47(4):317-20.

Manjunath V, Taha M, Fujimoto JG, Duker JS. Choroidal thickness in normal eyes measured using Cirrus HD optical coherence tomography. Am J Ophthalmol 2010;150(3):325-9.

Margolis R, Spaide RF. A pilot study of enhanced depth imaging optical coherence tomography of the choroid in normal eyes. Am J Ophthalmol 2009;147(5):811-5.

Shin JW, Shin YU, Cho HY, Lee BR. Measurement of cho- roidal thickness in normal eyes using 3D OCT-1000 spec- tral domain optical coherence tomography. Korean J Ophthalmol 2012;26(4):255-9.