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Romano J, Godinho G, Chaves J, Oliveira N, Sousa JP. Cytomegalovirus-Induced Hypertensive Anterior Uveitis: Diagnostic Challenge in an Immunocompetent Patient. Cureus 2024; 16:e52826. [PMID: 38406050 PMCID: PMC10884362 DOI: 10.7759/cureus.52826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 02/27/2024] Open
Abstract
Hypertensive anterior uveitis poses diagnostic challenges owing to its multiple potential etiologies. Cytomegalovirus (CMV) infection is an under-recognized cause that exhibits diverse clinical presentations. This case report focuses on the intricate diagnostic challenge encountered in a 66-year-old immunocompetent patient with CMV-induced hypertensive anterior uveitis. The patient's history, encompassing angle closure glaucoma and topiramate use, contributed to the hypertensive crisis. Initial management included intraocular pressure (IOP)-lowering medication, topiramate discontinuation, and bilateral phacoemulsification, successfully normalizing IOP. However, a subsequent recurrence prompted a detailed investigation. The identification of keratic precipitates and a synechial closed angle led to aqueous humor sampling and polymerase chain reaction (PCR) testing, unveiling the presence of CMV-DNA. Treatment led to a favorable response, resolving ocular inflammation and effectively controlling IOP. This case underscores the complexity of diagnosing and managing CMV-induced hypertensive anterior uveitis, emphasizing the critical role of a comprehensive approach in achieving successful outcomes.
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Affiliation(s)
- João Romano
- Ophthalmology, Centro Hospitalar de Leiria, Leiria, PRT
| | | | - João Chaves
- Ophthalmology, Centro Hospitalar de Leiria, Leiria, PRT
| | - Nuno Oliveira
- Ophthalmology, Centro Hospitalar de Leiria, Leiria, PRT
| | - João P Sousa
- Ophthalmology, Centro Hospitalar de Leiria, Leiria, PRT
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2
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Willems LM, van der Goten M, von Podewils F, Knake S, Kovac S, Zöllner JP, Rosenow F, Strzelczyk A. Adverse Event Profiles of Antiseizure Medications and the Impact of Coadministration on Drug Tolerability in Adults with Epilepsy. CNS Drugs 2023; 37:531-544. [PMID: 37271775 PMCID: PMC10239658 DOI: 10.1007/s40263-023-01013-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Antiseizure medication (ASM) as monotherapy or in combination is the treatment of choice for most patients with epilepsy. Therefore, knowledge about the typical adverse events (AEs) for ASMs and other coadministered drugs (CDs) is essential for practitioners and patients. Due to frequent polypharmacy, it is often difficult to clinically assess the AE profiles of ASMs and differentiate the influence of CDs. OBJECTIVE This retrospective analysis aimed to determine typical AE profiles for ASMs and assess the impact of CDs on AEs in clinical practice. METHODS The Liverpool AE Profile (LAEP) and its domains were used to identify the AE profiles of ASMs based on data from a large German multicenter study (Epi2020). Following established classifications, drugs were grouped according to their mode of action (ASMs) or clinical indication (CDs). Bivariate correlation, multivariate ordinal regression (MORA), and artificial neural network (ANNA) analyses were performed. Bivariate correlation with Fisher's z-transformation was used to compare the correlation strength of LAEP with the Hospital Anxiety and Depression Scale (HADS) and Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) to avoid LAEP bias in the context of antidepressant therapy. RESULTS Data from 486 patients were analyzed. The AE profiles of ASM categories and single ASMs matched those reported in the literature. Synaptic vesicle glycoprotein 2A (SV2A) and voltage-gated sodium channel (VGSC) modulators had favorable AE profiles, while brivaracetam was superior to levetiracetam regarding psychobehavioral AEs. MORA revealed that, in addition to seizure frequency, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) modulators and antidepressants were the only independent predictors of high LAEP values. After Fisher's z-transformation, correlations were significantly lower between LAEP and antidepressants than between LAEP and HADS or NDDI-E. Therefore, a bias in the results toward over interpreting the impact of antidepressants on LAEP was presumed. In the ANNA, perampanel, zonisamide, topiramate, and valproic acid were important nodes in the network, while VGSC and SV2A modulators had low relevance for predicting relevant AEs. Similarly, cardiovascular agents, analgesics, and antipsychotics were important CDs in the ANNA model. CONCLUSION ASMs have characteristic AE profiles that are highly reproducible and must be considered in therapeutic decision-making. Therapy using perampanel as an AMPA modulator should be considered cautiously due to its relatively high AE profile. Drugs acting via VGSCs and SV2A receptors are significantly better tolerated than other ASM categories or substances (e.g., topiramate, zonisamide, and valproate). Switching to brivaracetam is advisable in patients with psychobehavioral AEs who take levetiracetam. Because CDs frequently pharmacokinetically interact with ASMs, the cumulative AE profile must be considered. TRIAL REGISTRATION DRKS00022024, U1111-1252-5331.
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Affiliation(s)
- Laurent M Willems
- Epilepsy Center Frankfurt Rhine-Main, Goethe-University and University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
- Department of Neurology, Goethe-University and University Hospital Frankfurt, Frankfurt am Main, Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CEPTeR), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Milena van der Goten
- Epilepsy Center Frankfurt Rhine-Main, Goethe-University and University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
- Department of Neurology, Goethe-University and University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Felix von Podewils
- Department of Neurology, University Hospital Greifswald, Greifswald, Germany
| | - Susanne Knake
- LOEWE Center for Personalized Translational Epilepsy Research (CEPTeR), Goethe-University Frankfurt, Frankfurt am Main, Germany
- Epilepsy Center Hessen, Philipps-University Marburg, Marburg (Lahn), Germany
- Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany
| | - Stjepana Kovac
- Epilepsy Center Münster-Osnabrück, Westfälische Wilhelms-University, Münster, Germany
- Department of Neurology, Westfälische Wilhelms-University, Münster, Germany
| | - Johann Philipp Zöllner
- Epilepsy Center Frankfurt Rhine-Main, Goethe-University and University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
- Department of Neurology, Goethe-University and University Hospital Frankfurt, Frankfurt am Main, Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CEPTeR), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Goethe-University and University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
- Department of Neurology, Goethe-University and University Hospital Frankfurt, Frankfurt am Main, Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CEPTeR), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Goethe-University and University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany.
- Department of Neurology, Goethe-University and University Hospital Frankfurt, Frankfurt am Main, Germany.
- LOEWE Center for Personalized Translational Epilepsy Research (CEPTeR), Goethe-University Frankfurt, Frankfurt am Main, Germany.
- Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany.
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Silvestro M, Orologio I, Siciliano M, Trojsi F, Tessitore A, Tedeschi G, Russo A. Emerging drugs for the preventive treatment of migraine: a review of CGRP monoclonal antibodies and gepants trials. Expert Opin Emerg Drugs 2023. [PMID: 37185047 DOI: 10.1080/14728214.2023.2207819] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Migraine is a leading cause of years lived with disability and preventive strategies represent a mainstay to reduce health-related disability and improve quality of life of migraine patients. Until a few years ago, migraine prevention was based on drugs developed for other clinical indications and relocated in the migraine therapeutic armamentarium, characterized by unfavourable tolerability profiles. The advent of monoclonal antibodies against Calcitonin Gene-Related Peptide (CGRP) and gepants, CGRP receptor antagonists, has been a turning point in migraine prevention owing to advantageous efficacy, safety and tolerability profiles.Nevertheless, while in an ideal scenario a drug characterized by significant greater efficacy and tolerability compared to existing therapeutic strategies should be adopted as a first-line treatment, cost-effectiveness analyses available for monoclonal antibodies against CGRP pathway tend to limit their administration to more severe migraine phenotypes. AREAS COVERED The present narrative review aim to provide a critical appraisal of phase II and III CGRP-mAbs and gepants trials to analyse their use in clinical practice. EXPERT OPINION Despite monoclonal antibodies against CGRP pathway and gepants can be undoubtedly considered top-of-the-range treatments, there are still issues deserving to be addressed in the coming years as the risk of off-target effects as well as their economic sustainability based on the considerable migraine burden.
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Affiliation(s)
- Marcello Silvestro
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - Ilaria Orologio
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - Mattia Siciliano
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - Francesca Trojsi
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - Alessandro Tessitore
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - Gioacchino Tedeschi
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - Antonio Russo
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Italy
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Mabrouk DM, El Makawy AI, Ahmed KA, Ramadan MF, Ibrahim FM. Topiramate potential neurotoxicity and mitigating role of ginger oil in mice brain. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:87184-87199. [PMID: 35802336 DOI: 10.1007/s11356-022-21878-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/01/2022] [Indexed: 06/15/2023]
Abstract
Topiramate has multiple pharmacological mechanisms that are efficient in treating epilepsy and migraine. Ginger has been established to have gingerols and shogaols that cause migraine relief. Moreover, Topiramate has many off-label uses. Thus, it was necessary to explore the possible neurotoxicity of Topiramate and the role of ginger oil in attenuating the Topiramate neurotoxicity. Male albino mice were orally gavaged with Topiramate, ginger oil (400 mg/kg), and Topiramate plus ginger oil with the same pattern for 28 days. Oxidative stress markers, acetylcholinesterase (AchE), gamma-aminobutyric acid (GABA), and tumor necrosis factor-alpha (TNF-α) were examined. Histopathological examination, immunohistochemical glial fibrillary acidic protein (GFAP), and Bax expression analysis were detected. The GABAAR subunits, Gabra1, Gabra3, and Gabra5 expression, were assessed by RT-qPCR. The investigation showed that Topiramate raised oxidative stress markers levels, neurotransmitters, TNF-α, and diminished glutathione (GSH). In addition, Topiramate exhibited various neuropathological alterations, strong Bax, and GFAP immune-reactivity in the cerebral cortex. At the same time, the results indicated that ginger oil had no neurotoxicity. The effect of Topiramate plus ginger oil alleviated the changes induced by Topiramate in the tested parameters. Both Topiramate and ginger oil upregulated the mRNA expression of gabra1 and gabra3, while their interaction markedly downregulated them. Therefore, it could be concluded that the Topiramate overdose could cause neurotoxicity, but the interaction with ginger oil may reduce Topiramate-induced neurotoxicity and should be taken in parallel.
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Affiliation(s)
- Dalia M Mabrouk
- Cell Biology Department, Biotechnology Research Institute, National Research Centre, 33 El Bohouth St., Dokki, P.O. 12622, Giza, Egypt
| | - Aida I El Makawy
- Cell Biology Department, Biotechnology Research Institute, National Research Centre, 33 El Bohouth St., Dokki, P.O. 12622, Giza, Egypt
| | - Kawkab A Ahmed
- Pathology Department, Faculty of Veterinary Medicine, Cairo University, P.O. 12211, Giza, Egypt
| | - Mohamed Fawzy Ramadan
- Clinical Nutrition Department, College of Applied Medical Sciences, Umm Al-Qura University, P.O. Box 7067, Makkah, 21955, Saudi Arabia.
- Biochemistry Department, Faculty of Agriculture, Zagazig University, Zagazig, Egypt.
| | - Faten M Ibrahim
- Medicinal and Aromatic Plants Research Department, National Research Centre, 33 El Bohouth St., Dokki, P.O.12622, Giza, Egypt
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Use of Visual Electrophysiology to Monitor Retinal and Optic Nerve Toxicity of Medications. Biomolecules 2022; 12:biom12101390. [PMID: 36291599 PMCID: PMC9599231 DOI: 10.3390/biom12101390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/26/2022] [Accepted: 09/26/2022] [Indexed: 12/03/2022] Open
Abstract
It is important for clinicians to consider exposure to toxic substances and nutritional deficiencies when diagnosing and managing cases of vision loss. In these cases, physiologic damage can alter the function of key components of the visual pathway before morphologic changes can be detected by traditional imaging methods. Electrophysiologic tests can aid in the early detection of such functional changes to visual pathway components, including the retina or optic nerve. This review provides an overview of various electrophysiologic techniques, including multifocal electroretinogram (mfERG), full-field ERG (ffERG), electrooculogram (EOG), pattern electroretinogram (PERG), and visual evoked potential (VEP) in monitoring the retinal and optic nerve toxicities of alcohol, amiodarone, cefuroxime, cisplatin, deferoxamine, digoxin, ethambutol, hydroxychloroquine, isotretinoin, ocular siderosis, pentosane, PDE5 inhibitors, phenothiazines (chlorpromazine and thioridazine), quinine, tamoxifen, topiramate, vigabatrin, and vitamin A deficiency.
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Mechrgui M, Kanani S. The Ophthalmic Side Effects of Topiramate: A Review. Cureus 2022; 14:e28513. [PMID: 36059357 PMCID: PMC9420653 DOI: 10.7759/cureus.28513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 11/18/2022] Open
Abstract
Topiramate (TPM) is a sulfonamide drug with multiple modes of action. It inhibits carbonic anhydrase, blocks sodium channels, enhances potassium channels, and stimulates postsynaptic gamma-aminobutyric acid (GABA) receptors. Pharmacists Joe Gardocki and Bruce Maryanoff synthesized TPM for the first time in 1979. The FDA did not approve it for medical use in the US until 1996. Around 2004, it was authorized for the prevention of migraine headaches. TPM, like any medication, has several side effects. Common aftermaths include weight loss, diarrhea, dizziness, sleepiness, fatigue, and coordination issues. Some people may experience mental health issues like memory problems, confusion, and speech or language difficulties. The most well-known ocular side effects of TPM are choroidal effusion syndrome, angle-closure glaucoma, and myopic shift.
Aside from these, other ophthalmic adverse effects may arise in some people, including retinal problems, uveitis, visual field defects, myokymia, and neuro-ophthalmology complications. If such complications are not identified and treated promptly, they can be severe and vision-threatening, potentially leading to permanent blindness. TPM's application as a standalone and adjunctive therapy has increased over time. In 2019, more than 10 million prescriptions of TPM were issued. Due to its extensive use, medical professionals and patients must be aware of its potential repercussions, especially ophthalmic issues. The current review paper likewise makes a step in this direction. This article's primary purpose is to educate readers by providing a comprehensive assessment of the research on TPM's ocular side effects. All the information has been collected via a thorough search of the Google Search Engine and PubMed.
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Eye disorders due to newer antiseizure drugs in children. Seizure 2022; 96:94. [DOI: 10.1016/j.seizure.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 11/21/2022] Open
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Eye disorders associated with newer antiepileptic drugs: A real-world disproportionality analysis of FDA adverse event reporting system. Seizure 2022; 96:66-73. [DOI: 10.1016/j.seizure.2022.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/16/2022] [Accepted: 01/17/2022] [Indexed: 01/08/2023] Open
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Thabit MN, Farouk MM. Topiramate-induced ocular side effects in Egyptian patients, idiosyncratic versus dose-dependent effect, a prospective study. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-020-00263-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To test the nature of the ocular side effects induced by topiramate (TPM) whether dose dependent or idiosyncratic, and to test various predictors that might influence the occurrence of those side effects.
Methods
Twenty patients treated with TPM were included in this study. Patients underwent ophthalmic assessment before and after 4 weeks of treatment by stable doses of oral TPM. We examined non-cycloplegic refraction (RF) in diopters, best corrected visual acuity (BCVA), intraocular pressure (IOP) in mmHg, and anterior chamber depth (ACD) in mm.
Results
There were no statistically significant differences between baseline and follow-up assessments in all tested ophthalmological parameters including errors of RF, ACD, IOP, and the BCVA. One case suffered from painful drop of vision in both eyes with elevated IOP and decreased ACD, and evident myopic shift 1 week after treatment with small dose of TPM. There was no significant effect of age, TPM dose, disease, and gender on all tested variables.
Conclusion
TPM can induce idiosyncratic, but not dose dependent, ocular side effects, namely myopic shifts and angle closure glaucoma. Those side effects were not disease, age, or gender dependent. However, ethnicity might play a role in induction of those side effects.
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AlNaqeeb O, Aljohani S, Alshehri A. Topiramate-induced acute bilateral angle closure glaucoma confirmed by ultrasound biomicroscopy. Saudi J Ophthalmol 2021; 34:316-318. [PMID: 34527882 PMCID: PMC8409355 DOI: 10.4103/1319-4534.322600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 05/19/2019] [Accepted: 10/07/2019] [Indexed: 11/04/2022] Open
Abstract
Topiramate is a sulfamate-substituted monosaccharide used in the treatment of epilepsy and migraines. This case report demonstrates a 29-year-old female who complained of severe bilateral loss of vision 14 days after using topiramate for her migraine. On initial examination, visual acuities were counting fingers in both eyes. Intraocular pressures were 55 mmHg and 58 mmHg in the right and left eyes, respectively. Anterior segment examination showed bilateral conjunctival chemosis, mild corneal edema, and markedly shallow anterior chambers with closed angles on gonioscopy. Ultrasound biomicroscopy revealed bilateral anterior rotation of ciliary body with choroidal effusion. Topiramate was immediately discontinued, topical and systemic anti-glaucomatous treatment was administered. After 1-week follow-up, the patient had fully recovered.
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Affiliation(s)
| | - Saud Aljohani
- Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Ahmad R, Mehta H. The ocular adverse effects of oral drugs. Aust Prescr 2021; 44:129-136. [PMID: 34421178 PMCID: PMC8377292 DOI: 10.18773/austprescr.2021.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Some commonly prescribed drugs have ocular adverse effects. Many parts of the eye can be affected by oral drugs. Some ocular adverse effects may be reversed with medical or surgical intervention whereas other drugs may cause irreversible loss of vision The risk of visual loss can be reduced by a number of approaches, including monitoring for ocular toxicity, reducing the drug dose, or stopping the drug and looking for an alternative. This can be supported by good communication between the prescribing clinician and ophthalmologist Infrequent or delayed ocular adverse effects may not be identified in clinical trials of new drugs. Reporting adverse events is therefore important
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Affiliation(s)
| | - Hemal Mehta
- Strathfield Retina Clinic, Sydney.,Save Sight Registries, University of Sydney
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12
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Abstract
This article provides a practical review of the diagnosis and management of angle closure induced by psychotropic agents, including tricyclic antidepressants, antipsychotics and anticonvulsants. Selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, monoamine oxidase inhibitors and antipsychotics may trigger angle closure by influencing pupil configuration through adrenergic, anticholinergic, serotonergic or dopaminergic mechanisms. Patients with narrow iridocorneal angles are at risk, and these are more common in people with hypermetropia (near-sightedness), older people and individuals with an Asian background. These patients may benefit from a laser peripheral iridotomy, either prophylactically or to relieve an acute angle-closure episode. An idiosyncratic reaction to medications such as topiramate may lead to angle closure through an alternate mechanism, leading to a uveal effusion. Ophthalmological review may be considered prior to commencing medications in high-risk patients.
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Kim YJ, Chung J, Joo JH, Kim TG. Acute Myopic Shift and Change in Anterior Chamber Depth after Intake of Zonisamide. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.12.1538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Dutta Majumder P, Agrawal R, McCluskey P, Biswas J. Current Approach for the Diagnosis and Management of Noninfective Scleritis. Asia Pac J Ophthalmol (Phila) 2020; 10:212-223. [PMID: 33290287 DOI: 10.1097/apo.0000000000000341] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
ABSTRACT Scleritis is a rare, vision-threatening inflammation of the sclera that is often associated with life-threatening systemic illnesses. Rheumatoid arthritis remains the most common associated systemic rheumatic disease and the commonest systemic association of scleritis. Granulomatosis with polyangiitis is the most common cause of vasculitis-associated scleritis. The etiopathogenesis of scleritis remains unclear, but can be immune complex-mediated or due to a local delayed hypersensitivity reaction. Scleritis can involve either the anterior or posterior sclera, and has a wide spectrum of clinical presentations. Among the subtypes of scleritis, necrotizing scleritis has an increased risk of complications and is more commonly associated with anterior uveitis and peripheral ulcerative keratitis. Posterior scleritis is often not diagnosed or missed due to its subtle clinical signs and protean manifestations. Meticulous history taking, detailed ocular examination, and a targeted array of investigations with a multi-disciplinary approach to find any underlying systemic disease are crucial for the management of a case of scleritis. Corticosteroids remain the mainstay of short-term treatment of scleritis; mild to moderate scleral inflammation may respond well to treatment with nonsteroidal antiinflammatory drug or topical corticosteroid. Corticosteroid-sparing immunosuppressive therapies are useful in cases with an inadequate response or failure to provide long-term control of inflammation, and to prevent recurrence of scleritis. Biologic agents are increasingly used in the management of scleritis, not responding to the conventional therapies. This review provides an overview of the various subtypes of scleritis and its systemic associations and evaluates current trends in the diagnosis and management of noninfective scleritis.
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Affiliation(s)
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Peter McCluskey
- Ocular Infections and Antimicrobials Research Group, Singapore Eye Research Institute, Singapore
| | - Jyotirmay Biswas
- Department of Uveitis and Ocular Pathology, Sankara Nethralaya, Chennai, India
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Abstract
PURPOSE To describe a case of zonisamide-induced bilateral choroidal effusion. CASE REPORT A 72-year-old woman presented with a 4-day history of bilateral blurred vision 9 days after initiating oral zonisamide for essential tremor. Clinical examination revealed an asymmetric choroidal detachment with open anterior chamber angle and intraocular pressure within the normal range. Posterior segment ultrasonography and ultrasound biomicroscopy both confirmed the presence of bilateral ciliochoroidal effusion. Zonisamide treatment was discontinued. One month after treatment discontinuation, the ophthalmological examination was normal and no further treatment was needed. CONCLUSION Zonisamide can cause an idiosyncratic reaction leading to choroidal effusion with or without acute angle closure. Early withdrawal of the causative agent is the key to reversing this condition. These findings indicate that zonisamide and other sulfa-derived drugs must be ruled out in the differential diagnosis of choroidal effusion of unknown cause.
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Vuppala AAD, Griepentrog GJ, Walsh RD. Swallow-Induced Eyelid Myokymia: A Novel Synkinesis Syndrome. Neuroophthalmology 2020; 44:108-110. [DOI: 10.1080/01658107.2019.1587637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 02/12/2019] [Accepted: 02/23/2019] [Indexed: 10/27/2022] Open
Affiliation(s)
- Amrita-Amanda D. Vuppala
- Department of Neurology and Ophthalmology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Gregory J. Griepentrog
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Ryan D. Walsh
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Muñoz Morales A, Sánchez-Vicente JL, Franco Ruedas C, de Las Morenas Iglesias J, Espiñeira Periñán MÁ, López-Herrero F. Macular neurosensory retinal detachment associated with topiramate use. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2019; 94:614-618. [PMID: 31610900 DOI: 10.1016/j.oftal.2019.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 07/17/2019] [Accepted: 07/22/2019] [Indexed: 06/10/2023]
Abstract
A 36 year-old woman with idiopathic intracranial hypertension was treated with topiramate and acetazolamide. The patient was followed-up for 2 years, with a relationship between neurosensory detachments and topiramate being established, with recurrences after the introduction of topiramato and improvement after its withdrawal. These findings point topiramate as a possible cause of the clinical picture. Topiramate may cause retinal and macular neurosensory detachments. Although the ciliochoroidal effusion cases caused by this drug are well-known, its retinal side effects are less common. As it is a widely used drug, neurologists and ophthalmologists should be aware of its possible ocular side effects.
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Affiliation(s)
- A Muñoz Morales
- Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | | | - C Franco Ruedas
- Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | | | | | - F López-Herrero
- Oftalmología, Hospital Universitario Virgen del Rocío, Sevilla, España
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Kang YK, Son BJ, Park DH, Shin JP. Angiographic features of drug-induced bilateral angle closure and transient myopia with Ciliochoroidal effusion. BMC Ophthalmol 2019; 19:213. [PMID: 31684898 PMCID: PMC6829858 DOI: 10.1186/s12886-019-1230-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 10/28/2019] [Indexed: 11/21/2022] Open
Abstract
Background To report five cases of acute drug-induced angle closure and transient myopia with ciliochoroidal effusion and to analyze angiographic findings of these cases. Methods This study is an observational case series. Five patients with acute drug-induced angle closure and transient myopia with ciliochoroidal effusion were examined by fluorescein angiography, indocyanine green angiography (ICGA) and ultrasound biomicroscopy (UBM). Results Five patients presented with bilateral visual loss and ocular pain after intake of topiramate, methazolamide, phendimetrazine tartrate or mefenamic acid. All patients showed elevated intraocular pressure (IOP) with shallow anterior chamber and myopic shift from − 0.5 to − 17.0 diopters (D). UBM showed ciliochoroidal effusions with diffuse thickening of the ciliary body in all cases. Rapid normalization of IOP and decrease of myopic shift occurred in all patients after discontinuing the suspected drugs. We classified the ICGA findings into 2 major signs (hypofluorescent dark spots, hyperfluorescent pinpoints) and 3 minor signs (diffuse choroidal hyperfluorescence, early hyperfluorescence of choroidal stromal vessel, and leakage and dilated retinal vessels). Conclusions The pathogenesis of acute drug-induced angle closure and transient myopia with ciliochoroidal effusion may be idiosyncratic reaction of uveal tissue to systemic drugs. Accumulation of extravascular fluid in the ciliochoroidal layer had a major role in the pathogenesis. ICGA could be a useful method to examine the pathophysiology of this condition by imaging of the choroidal layer.
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Affiliation(s)
- Yong Koo Kang
- Department of Ophthalmology, School of Medicine, Kyungpook National University, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, South Korea
| | - Byeong Jae Son
- Department of Ophthalmology, School of Medicine, Kyungpook National University, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, South Korea
| | - Dong Ho Park
- Department of Ophthalmology, School of Medicine, Kyungpook National University, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, South Korea
| | - Jae Pil Shin
- Department of Ophthalmology, School of Medicine, Kyungpook National University, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, South Korea.
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Diaz-Cespedes RA, Toro-Giraldo D, Olate-Perez A, Hervas-Ontiveros A, Garcia-Delpech S, Udaondo-Mirete P. Contribution of the Visante ® OCT and B-scan ultrasound in the diagnosis and follow up of a topiramate-induced bilateral ciliochoroidal effusion syndrome. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2019; 94:391-395. [PMID: 30738599 DOI: 10.1016/j.oftal.2019.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 12/25/2018] [Accepted: 01/07/2019] [Indexed: 06/09/2023]
Abstract
A 45 year-old man with bilateral acute angle-closure and myopia after starting treatment with topiramate, secondary to alcohol and heroin dependence. Using Visante® OCT (Optical Coherence Tomography) and B-scan Ultrasound he was diagnosed with bilateral ciliochoroidal effusion as the pathophysiological mechanism. Topiramate was stopped and ocular hypotensive therapy with a topical cycloplegic and corticosteroids were started, resolving ciliochoroidal effusion syndrome. Visante® OCT and B-scan Ultrasound are useful tools for the diagnosis and follow-up of patients with acute angle-closure and myopia due to topiramate. As a result of broad spectrum of indications for topiramate, physicians and ophthalmologists should be aware of the possible ophthalmological manifestations attributable to this drug.
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Affiliation(s)
| | - D Toro-Giraldo
- Servicio de Oftalmología, Hospital Clínico Universitario de Valencia, Valencia, España
| | - A Olate-Perez
- Servicio de Oftalmología, Hospital Obispo Polanco de Teruel, Teruel, España
| | | | - S Garcia-Delpech
- Servicio de Oftalmología, Hospital Universitario y Politécnico de la Fe, Valencia, España
| | - P Udaondo-Mirete
- Servicio de Oftalmología, Hospital Universitario y Politécnico de la Fe, Valencia, España
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21
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Brill D, Albert D, Fields T, Mikkilineni S, Crandall D, Gao H. Ciliochoroidal effusion syndrome with central serous-like chorioretinopathy and secondary angle closure following exogenous testosterone use. Am J Ophthalmol Case Rep 2019; 15:100482. [PMID: 31198887 PMCID: PMC6557563 DOI: 10.1016/j.ajoc.2019.100482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 05/30/2019] [Accepted: 05/30/2019] [Indexed: 11/16/2022] Open
Abstract
Purpose To report a unique presentation of ciliochoroidal effusion syndrome with central serous-like chorioretinopathy and secondary angle closure following exogenous testosterone use. Observations A 37 year-old man presented with a two week history of blurred vision, elevated intraocular pressure, and myopic shift in his right eye. Gonioscopy showed angle closure. After YAG iridotomy, ultrasound biomicroscopy (UBM) showed ciliochoroidal effusion and anterior rotation of the ciliary processes. Subsequent color fundus photography, enhanced depth imaging optical coherence tomography (EDI-OCT) and near-infrared reduced-illuminance autofluorescence imaging (NIR-RAFI) showed macular striae, choroidal folds, and increased choroidal thickness without presence of subretinal fluid (SRF) or pigment epithelial detachment (PED). Further questioning revealed the patient was using dermal testosterone gel for six months for treatment of hypogonadism. The patient stopped using the testosterone gel, and his visual acuity and intraocular pressure significantly improved six weeks later. Follow-up UBM showed significant improvement of the ciliochoroidal effusion, and repeat multimodal images demonstrated resolution of the macular striae and choroidal folds, and slightly improved choroidal thickness. Conclusions and importance Our patient demonstrates a rare case of ciliochoroidal effusion, central serous-like chorioretinopathy, and secondary angle closure that dramatically improved with cessation of testosterone. We believe that this unique clinical constellation is the first to be reported associated with exogenous testosterone use.
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Affiliation(s)
- Daniel Brill
- Henry Ford Health System, Department of Ophthalmology, Detroit, MI, USA
| | - Desiree Albert
- Henry Ford Health System, Department of Ophthalmology, Detroit, MI, USA
| | - Taylor Fields
- Henry Ford Health System, Department of Ophthalmology, Detroit, MI, USA
| | | | - David Crandall
- Henry Ford Health System, Department of Ophthalmology, Detroit, MI, USA
| | - Hua Gao
- Henry Ford Health System, Department of Ophthalmology, Detroit, MI, USA
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Hamed SA. Ocular dysfunctions and toxicities induced by antiepileptic medications: Types, pathogenic mechanisms, and treatment strategies. Expert Rev Clin Pharmacol 2019; 12:309-328. [PMID: 30840840 DOI: 10.1080/17512433.2019.1591274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Ocular dysfunctions and toxicities induced by antiepileptic drugs (AEDs) are rarely reviewed and not frequently received attention by treating physicians compared to other adverse effects (e.g. endocrinologic, cognitive and metabolic). However, some are frequent and progressive even in therapeutic concentrations or result in permanent blindness. Although some adverse effects are non-specific, others are related to the specific pharmacodynamics of the drug. Areas covered: This review was written after detailed search in PubMed, EMBASE, ISI web, SciELO, Scopus, and Cochrane Central Register databases (from 1970 to 2019). It summarized the reported ophthalmologic adverse effects of the currently available AEDs; their risks and possible pathogenic mechanisms. They include ocular motility dysfunctions, retinopathy, maculopathy, glaucoma, myopia, optic neuropathy, and impaired retinal vascular autoregulation. In general, ophthalmo-neuro- or retino-toxic adverse effects of AEDs are classified as type A (dose-dependent), type B (host-dependent or idiosyncratic) or type C which is due to the cumulative effect from long-term use. Expert opinion: Ocular adverse effects of AEDs are rarely reviewed although some are frequent or may result in permanent blindness. Increasing knowledge of their incidence and improving understanding of their risks and pathogenic mechanisms are crucial for monitoring, prevention, and management of patients' at risk.
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Affiliation(s)
- Sherifa A Hamed
- a Department of Neurology and Psychiatry , Assiut University Hospital , Assiut , Egypt
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23
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Verrotti A, Iapadre G, Di Donato G, Di Francesco L, Zagaroli L, Matricardi S, Belcastro V, Iezzi ML. Pharmacokinetic considerations for anti-epileptic drugs in children. Expert Opin Drug Metab Toxicol 2019; 15:199-211. [PMID: 30689454 DOI: 10.1080/17425255.2019.1575361] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Epilepsy is a chronic and debilitating neurological disease, with a peak of incidence in the first years of life. Today, the vast armamentarium of antiepileptic drugs (AEDs) available make even more challenging to select the most appropriate AED and establish the most effective dosing regimen. In fact, AEDs pharmacokinetics is under the influence of important age-related factors which cannot be ignored. Areas covered: Physiological changes occurring during development age (different body composition, immature metabolic patterns, reduced renal activity) can significantly modify the pharmacokinetic profile of AEDs (adsorption, volume of distribution, half-life, clearance), leading to an altered treatment response. We reviewed the main pharmacokinetic characteristics of AEDs used in children, focusing on age-related factors which are of relevance when treating this patient population. Expert opinion: To deal with this pharmacokinetic variability, physicians have at their disposal two tools: 1) therapeutic drug concentration monitoring, which may help to set the optimal therapeutic regimen for each patient and to monitor eventual fluctuation, and 2) the use of extended-release drug formulations, when available. In the next future, the development of 'ad-hoc' electronic dashboard systems will represent relevant decision-support tools making the AED therapy even more individualized and precise, especially in children.
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Affiliation(s)
- Alberto Verrotti
- a Department of Pediatrics , University of L'Aquila , L'Aquila , Italy
| | - Giulia Iapadre
- a Department of Pediatrics , University of L'Aquila , L'Aquila , Italy
| | - Giulia Di Donato
- a Department of Pediatrics , University of L'Aquila , L'Aquila , Italy
| | | | - Luca Zagaroli
- a Department of Pediatrics , University of L'Aquila , L'Aquila , Italy
| | - Sara Matricardi
- b Child Neurology and Psychiatry Unit , Children's Hospital G. Salesi , Ancona , Italy
| | | | - Maria Laura Iezzi
- a Department of Pediatrics , University of L'Aquila , L'Aquila , Italy
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DE OLIVEIRA BMR, FERRARI PV, HERRERIAS BT, HIRAI FE, GRACITELLI CPB. The Use of Topiramate for Weight Loss Causing Acute Glaucoma: A Case Report and Literature Review. MEDICAL HYPOTHESIS, DISCOVERY & INNOVATION OPHTHALMOLOGY JOURNAL 2019; 8:116-120. [PMID: 31263722 PMCID: PMC6592302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Topiramate is a sulfa-containing drug which is able to disrupt the ocular blood barrier. Recently it has gained more popularity, being used in many clinical conditions. Nowadays, the cases of glaucoma induced by topiramate have increased due to the use of this drug to induce weight loss. We here described a 29-year-old female presented with a one-day history of blurred vision in both eyes and headache. She was using a weight loss formula containing topiramate 100 milligrams. Ophthalmologic exam revealed an important myopic shift of -7.00 spherical diopters at presentation with intraocular pressure (IOP) of 32 mmHg and a shallow anterior chamber in both eyes. After discontinuous of topiramate and use of cycloplegic eyedrops, myopic shift improved and IOP controlled after two days. The anterior chamber was significantly deeper in both eyes after two weeks. It is theorized that topiramate can provoke a ciliochoroidal effusion and, therefore, can cause an anterior displacement of lens-iris diaphragm with a secondary angular closure. The treatment must include cycloplegic and discontinuation of the drug. Sulfa-containing drugs lead to an indirect mechanism of angle closure, frequently bilateral and, as mentioned above, with a different treatment approach. If unrecognized and untreated, it can provoke high morbidity with possibility of bilateral permanent visual loss.
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Affiliation(s)
| | - Pedro Vanalle FERRARI
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil,Glaucoma Unit, Ver Mais Oftalmologia, São Paulo, Brazil
| | - Bruno Torres HERRERIAS
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil,Glaucoma Unit, Ver Mais Oftalmologia, São Paulo, Brazil
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Mavrommatis MA, Jung H, Chari A, Barlogie B, Chelnis JG. Daratumumab-induced transient myopic shift. Am J Ophthalmol Case Rep 2018; 13:116-118. [PMID: 30619976 PMCID: PMC6312830 DOI: 10.1016/j.ajoc.2018.12.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 11/19/2018] [Accepted: 12/17/2018] [Indexed: 11/18/2022] Open
Abstract
Purpose To describe an unprecedented case of transient myopic shift induced by a chemotherapeutic agent, daratumumab. Observations A 43-year-old emmetropic female with multiple myeloma experienced sudden onset of myopic shift during her first intravenous dose of daratumumab, an increasingly common FDA-approved chemotherapeutic agent. Her myopia was corrected with -4D lenses in both eyes, and the patient reports cessation of symptoms and disuse of lenses after two days. Conclusions and importance A number of medications have been documented to induce transitory myopic shift, and this report now includes daratumumab among such agents. Further clinical findings regarding the mechanism and frequency of daratumumab-induced myopic shift are needed to further develop our understanding of its tangential effect on the eye.
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Affiliation(s)
- Maria A. Mavrommatis
- Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, New York, NY, 10029, USA
- Corresponding author.
| | - Hoon Jung
- Department of Ophthalmology, University of Washington, Box 259608 325 Ninth Avenue, Seattle, WA, 98104, USA
| | - Ajai Chari
- Department of Hematology-Oncology, Mount Sinai Medical Center, 1468 Madison Ave, New York, NY, 10029, USA
| | - Bart Barlogie
- Department of Hematology-Oncology, Mount Sinai Medical Center, 1468 Madison Ave, New York, NY, 10029, USA
| | - James G. Chelnis
- Department of Ophthalmology, Mount Sinai Medical Center, 1468 Madison Ave, New York, NY, 10029, USA
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Iapadre G, Balagura G, Zagaroli L, Striano P, Verrotti A. Pharmacokinetics and Drug Interaction of Antiepileptic Drugs in Children and Adolescents. Paediatr Drugs 2018; 20:429-453. [PMID: 30003498 DOI: 10.1007/s40272-018-0302-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Selecting the most appropriate antiepileptic drug (AED) or combination of drugs for each patient and identifying the most suitable therapeutic regimen for their needs is increasingly challenging, especially among pediatric populations. In fact, the pharmacokinetics of several drugs vary widely in children with epilepsy because of age-related factors, which can influence the absorption, distribution, metabolism, and elimination of the pharmacological agent. In addition, individual factors, such as seizure type, associated comorbidities, individual pharmacokinetics, and potential drug interactions, may contribute to large fluctuations in serum drug concentrations and, therefore, clinical response. Therapeutic drug concentration monitoring (TDM) is an essential tool to deal with this complexity, enabling the definition of individual therapeutic concentrations and adaptive control of dosing to minimize drug interactions and prevent loss of efficacy or toxicity. Moreover, pharmacokinetic/pharmacodynamic modelling integrated with dashboard systems have recently been tested in antiepileptic therapy, although more clinical trials are required to support their use in clinical practice. We review the mechanism of action, pharmacokinetics, drug-drug interactions, and safety/tolerability profiles of the main AEDs currently used in children and adolescents, paying particular regard to issues of relevance when treating this patient population. Indications for TDM are provided for each AED as useful support to the clinical management of pediatric patients with epilepsy by optimizing pharmacological therapy.
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Affiliation(s)
- Giulia Iapadre
- Department of Pediatrics, University of L'Aquila, Via Vetoio, 1. Coppito, L'Aquila, Italy
| | - Ganna Balagura
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Opthalmology, Genetics, Maternal and Child Health, University of Genoa, "G. Gaslini" Institute, Genoa, Italy
| | - Luca Zagaroli
- Department of Pediatrics, University of L'Aquila, Via Vetoio, 1. Coppito, L'Aquila, Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Opthalmology, Genetics, Maternal and Child Health, University of Genoa, "G. Gaslini" Institute, Genoa, Italy
| | - Alberto Verrotti
- Department of Pediatrics, University of L'Aquila, Via Vetoio, 1. Coppito, L'Aquila, Italy.
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Yavuz C, Ozcimen M. An evaluation of peripapillar choroidal thickness in patients receiving systemic isotretinoin treatment. Cutan Ocul Toxicol 2018; 38:25-28. [DOI: 10.1080/15569527.2018.1503289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Cahit Yavuz
- Department of Dermatology, Konya Training and Research Hospital, Konya, Turkey
| | - Muammer Ozcimen
- Department of Ophtalmology, Konya Training and Research Hospital, Konya, Turkey
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28
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Moavero R, Pisani LR, Pisani F, Curatolo P. Safety and tolerability profile of new antiepileptic drug treatment in children with epilepsy. Expert Opin Drug Saf 2018; 17:1015-1028. [PMID: 30169997 DOI: 10.1080/14740338.2018.1518427] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Treatment of pediatric epilepsy requires a careful evaluation of the safety and tolerability profile of antiepileptic drugs (AEDs) to avoid or minimize as much as possible adverse events (AEs) on various organs, hematological parameters, and growth, pubertal, motor, cognitive and behavioral development. AREAS COVERED Treatment-emergent AEs (TEAEs) reported in the literature 2000-2018 regarding second- and third-generation AEDs used in the pediatric age, with exclusion of the neonatal period that exhibits specific peculiarities, have been described on the basis of their frequency, severity/tolerability, and particular association with a given AED. EXPERT OPINION Somnolence/sedation and behavioral changes, like irritability and nervousness, are among the most commonly observed TEAEs associated with almost all AEDs. Lamotrigine, Gabapentin, Oxcarbazepine, and Levetiracetam appear to be the best-tolerated AEDs with a ≤2% withdrawal rate, while Tiagabine and Everolimus are discontinued in up to >20% of the patients because of intolerable TEAEs. For some AEDs, literature data are scanty to draw a high-level evidence on their safety and tolerability profile. The reasons are: insufficient population size, short duration of treatments, or lack of controlled trials. A future goal is that of identifying clearer, easier, and more homogeneous methodological strategies to facilitate AED testing in pediatric populations.
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Affiliation(s)
- Romina Moavero
- a Child Neurology and Psychiatry Unit, Systems Medicine Department , Tor Vergata University of Rome , Rome , Italy.,b Child Neurology Unit, Neuroscience and Neurorehabilitation Department , "Bambino Gesù", Children's Hospital, IRCCS , Rome , Italy
| | | | - Francesco Pisani
- d Department of Clinical and Experimental Medicine , University of Messina , Messina , Italy
| | - Paolo Curatolo
- a Child Neurology and Psychiatry Unit, Systems Medicine Department , Tor Vergata University of Rome , Rome , Italy
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Mazumdar S, Tripathy K, Sarma B, Agarwal N. Acquired myopia followed by acquired hyperopia due to serous neurosensory retinal detachment following topiramate intake. Eur J Ophthalmol 2018; 29:NP21-NP24. [PMID: 30175623 DOI: 10.1177/1120672118797286] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE: To report a patient with fluctuating refraction following the use of oral topiramate. CASE REPORT: A 38-year-old male patient was diagnosed elsewhere with sudden-onset-acquired myopia, high intraocular pressure, and bilateral angle closure glaucoma for which he underwent laser peripheral iridotomy in both eyes and was started on topical antiglaucoma medications and topical steroids following laser peripheral iridotomy. He was referred for ultrasound biomicroscopy, which showed bilateral ciliary effusion. Ultrasound of eyes revealed choroidal thickening. On further questioning, he was noted to have taken oral topiramate for 7 days, which he stopped a week before the ocular symptoms. He was started on atropine, on which the acquired myopia resolved, the anterior chamber deepened, and the intraocular pressure came down. After 4 days, he developed acquired hyperopia in the left eye. Neurosensory retinal detachment at the posterior pole was documented with optical coherence tomography. The fluorescein angiography showed few ink-blot leaks and one smokestack leak in the left eye. The neurosensory detachment resolved spontaneously with an uncorrected visual acuity of 6/6 in either eye. CONCLUSION: A unique case of central serous chorioretinopathy following oral intake of topiramate is presented. This patient had also received laser peripheral iridotomy and topical steroids following the peripheral iridotomy.
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Affiliation(s)
- Shahana Mazumdar
- 1 Department of Ophthalmology, ICARE Eye Hospital and Postgraduate Institute, Noida, India
| | - Koushik Tripathy
- 1 Department of Ophthalmology, ICARE Eye Hospital and Postgraduate Institute, Noida, India
| | - Barsha Sarma
- 1 Department of Ophthalmology, ICARE Eye Hospital and Postgraduate Institute, Noida, India
| | - Neetu Agarwal
- 2 Department of Ophthalmology, NEO Hospital, Noida, India
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Lam L, Wang N, Ormonde S, Merriman M. Topiramate‐induced secondary angle closure: salient points in management. Clin Exp Optom 2018; 101:704-706. [PMID: 29656476 DOI: 10.1111/cxo.12685] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 03/07/2018] [Accepted: 03/07/2018] [Indexed: 11/28/2022] Open
Affiliation(s)
- Lewis Lam
- Ophthalmology Department, Waikato Hospital, Hamilton, New Zealand
| | - Nancy Wang
- Ophthalmology Department, Greenlane Clinical Centre, Auckland, New Zealand
| | - Sue Ormonde
- Ophthalmology Department, Greenlane Clinical Centre, Auckland, New Zealand
| | - Michael Merriman
- Ophthalmology Department, Waikato Hospital, Hamilton, New Zealand
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31
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Diep MQ, Madigan MC. Choroidal detachments: what do optometrists need to know? Clin Exp Optom 2018; 102:116-125. [PMID: 29971817 DOI: 10.1111/cxo.12807] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 06/01/2018] [Accepted: 06/03/2018] [Indexed: 11/30/2022] Open
Abstract
Choroidal detachments occur when there is an accumulation of fluid or blood in the suprachoroidal space, a potential space situated between the choroid and the sclera. They are an uncommon ocular pathology. The most common cause of choroidal detachment is secondary to trabeculectomy; however, there are other causes such as trauma and inflammation. Clinically, choroidal detachments may vary in presentation from asymptomatic, to very poor vision, severe ocular pain, vomiting and nausea. Ocular findings associated with choroidal detachments include serous retinal detachment, secondary angle closure, and a very shallow anterior chamber. Optometrists, as primary eye care providers, need to be aware of the clinical signs and symptoms associated with choroidal detachments and ensure that appropriate and timely management, with a referral to an ophthalmologist, is instigated for optimal visual outcomes. In this review, the pathophysiology, detection, and associated risk factors for choroidal detachments are discussed, and evidence-based management recommendations in an optometric context are provided. The characteristics and management of uveal effusion syndrome are also reviewed, as this can cause idiopathic exudative choroidal detachments distinct from classical choroidal detachment.
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Affiliation(s)
- Martin Q Diep
- School of Optometry and Vision Science, The University of New South Wales, Kensington, New South Wales, Australia
| | - Michele C Madigan
- School of Optometry and Vision Science, The University of New South Wales, Kensington, New South Wales, Australia.,Save Sight Institute, Discipline of Clinical Ophthalmology, The University of Sydney, Sydney, New South Wales, Australia
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Topiramate-induced macular neurosensory retinal detachment. Am J Ophthalmol Case Rep 2017; 7:31-37. [PMID: 29260075 PMCID: PMC5722185 DOI: 10.1016/j.ajoc.2017.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 05/16/2017] [Indexed: 11/23/2022] Open
Abstract
Purpose To present a previously unreported retinal side-effect from topiramate use in two cases. Observations Macular neurosensory retinal detachments were seen in two patients shortly after beginning oral topiramate. The macular detachments resolved shortly after discontinuing this medication. Conclusions and importance As these two cases represent the first reports of topiramate-induced macular neurosensory retinal detachment, clinicians should be aware of this potential ocular side effect when administering this medication.
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34
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Lan YW, Hsieh JW. Bilateral acute angle closure glaucoma and myopic shift by topiramate-induced ciliochoroidal effusion: case report and literature review. Int Ophthalmol 2017; 38:2639-2648. [PMID: 29063980 DOI: 10.1007/s10792-017-0740-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 10/05/2017] [Indexed: 01/06/2023]
Abstract
PURPOSE To report two cases of ciliochoroidal effusion after the usage of topiramate. CASES Two middle-aged women experienced sudden onset of acute glaucoma and acquired myopia after taking topiramate. Ultrasound biomicroscopy demonstrated bilateral ciliochoroidal effusion and angle closure. The A-scan ultrasonography revealed shallow anterior chamber and thick lens. After the treatment and drug withdrawal, intraocular pressure, refractive status and angle anatomy returned to normal and there was resolution of ciliochoroidal effusion. During the clinical course, the anterior chamber depth (ACD) increased from 2.02 to 3.30 mm (1.28 mm of changes) OD and from 1.94 to 3.36 mm (1.42 mm of changes) OS. The lens thickness (LT) became thinner from 4.53 to 4.31 mm (0.22 mm of changes) OD and from 4.59 to 4.30 mm (0.29 mm of changes) OS in the first case. In the second case, the ACD increased from 2.33 to 3.07 mm (0.74 mm of changes) OD and from 2.30 to 3.05 mm (0.75 mm of changes) OS. The LT became thinner from 4.42 to 4.27 mm (0.15 mm of changes) OD and from 4.38 to 4.26 mm (0.12 mm of changes) OS. The forward displacement of the lens-iris diaphragm contributed more to the shallowness of the anterior chamber than the thickening of the lens itself (only accounting for 20%). CONCLUSION Topiramate-induced bilateral acute angle closure glaucoma and myopic shift was due to ciliochoroidal effusion which resulted in thicker lens and shallow anterior chamber. The later was mainly due to anterior displacement of the lens-iris diaphragm.
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Affiliation(s)
- Yu-Wen Lan
- Department of Ophthalmology, MacKay Memorial Hospital, No. 92, Sec. 2, Chung Shan N. Rd., Taipei, 104, Taiwan. .,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan. .,MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan.
| | - Jui-Wen Hsieh
- Department of Ophthalmology, MacKay Memorial Hospital, No. 92, Sec. 2, Chung Shan N. Rd., Taipei, 104, Taiwan.,Department of Ophthalmology, National Taiwan University, Taipei, Taiwan.,Taipei Medical University, Taipei, Taiwan
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Joshi AK, Pathak AH, Patwardhan SD, Kulkarni AN. A Rare Case of Topiramate Induced Secondary Acute Angle Closure Glaucoma. J Clin Diagn Res 2017; 11:ND01-ND03. [PMID: 28764211 DOI: 10.7860/jcdr/2017/28093.10052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 04/25/2017] [Indexed: 11/24/2022]
Abstract
Secondary Acute Angle Closure Glaucoma (AACG) is a known side effect of Topiramate (TPM). Here, we present a case report of a 47-year-old male who was started on TPM 25 mg/day for migraine. He presented to the ophthalmology department of our hospital with sudden blurring of vision and colored halos after one day of starting TPM. A high index of suspicion, followed by appropriate investigations and prompt management that helped to manage TPM induced bilateral AACG with quick and complete visual recovery.
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Affiliation(s)
- Ajit Kamalakar Joshi
- Professor, Department of Ophthalmology, Bharati Vidyapeeth Deemed University Medical College and Hospital, Sangli, Maharashtra, India
| | - Amit Hemant Pathak
- Junior Resident, Department of Ophthalmology, Bharati Vidyapeeth Deemed University Medical College and Hospital, Sangli, Maharashtra, India
| | | | - Anil Narayan Kulkarni
- Professor and HOD, Department of Ophthalmology, Bharati Vidyapeeth Deemed University Medical College and Hospital, Sangli, Maharashtra, India
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Gok M, Ozdemir O. Effect of topiramate on choroidal thickness and anterior chamber parameters in the treatment of patients with migraine. Cutan Ocul Toxicol 2017; 36:381-386. [PMID: 28351170 DOI: 10.1080/15569527.2017.1311337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To investigate the effects of topiramate on choroidal thickness and anterior chamber parameters using optical coherence tomography in the treatment of patients with migraine. METHODS A total of 22 eyes of 22 adults (12 females, 10 males) diagnosed with migraine and scheduled to topiramate treatment for pain control were recruited in this prospective study. Choroidal thickness (CT), anterior chamber depth (ACD), anterior chamber angle (ACA), spherical refractive equivalent (SphEq) and intraocular pressure (IOP) measurements were recorded at baseline (prior the topiramate therapy), first and second month visits for the statistical analysis. One-way ANOVA with repeated measures test was used for the statistical evaluation. RESULTS Mean age of the patients was 40.2 ± 6.5 years. Mean CT at central fovea was 324 ± 47 μm initially, 341 ± 45 μm in the first month and 344 ± 46 μm in the second month, thus first and second month measures were significantly higher than base values (p < 0.001). There was also a slight increase in IOP values among baseline (15.5 ± 2.4 mmHg) and follow-up visits (17.5 ± 2.6 mmHg, 19.0 ± 3.3 mmHg, respectively, ` p = 0.001). Baseline ACD (3.66 ± 0.22 mm) measures significantly decreased at the first month (3.63 ± 0.22 mm) and second month (3.62 ± 0.22 mm, p = 0.009). Also, a significant reduction was detected in the first (36.2 ± 4.9°) and second month (35.9 ± 5.1°) ACA measures comparing with baseline (39.1 ± 5.1°, p = 0.05). A significant myopic shift was determined in the first and second month SphEq values (-0.08 ± 0.6, -0.10 ± 0.6, respectively, p = 0.05). CONCLUSIONS The study revealed increased CT and altered anterior chamber parameters and IOP due to topiramate therapy. Therefore, the patients using topiramate should be carefully monitored by an ophthalmologist considering the possible side effects.
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Affiliation(s)
- Mustafa Gok
- a Department of Ophthalmology , Ordu University Faculty of Medicine , Ordu , Turkey and
| | - Ozdemir Ozdemir
- b Department of Ophthalmology , Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey
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Çerman E, Akkaya Turhan S, Eraslan M, Kahraman Koytak P, Kilinç Ö, Tanrıdağ T. Topiramate and accommodation: Does topiramate cause accommodative dysfunction? Can J Ophthalmol 2017; 52:20-25. [PMID: 28237143 DOI: 10.1016/j.jcjo.2016.07.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 06/26/2016] [Accepted: 07/18/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate the accommodation function in topiramate users. DESIGN Case-control clinical study. PARTICIPANTS The participants included 16 controls and 22 patients using 100 mg/kg topiramate who were diagnosed with migraine according to the International Classification of Headache Disorders, second edition criteria. METHODS One-minute dynamic measurements of refraction with accommodation stimuli of 0 D, 2 D, 2.5 D, 3 D, 4 D, and 5 D were obtained using the open field refractometer WAM-5500 in. RESULTS In most of the accommodation stimuli ranges (0 D, 2.5 D, 3 D, and 5 D), topiramate users had a significantly higher accommodative lag compared with controls (p = 0.028, p = 0.014, p = 0.011, and p = 0.011, respectively). The most important causes of accommodative lag were found to be accommodation stimulus and inclusion in the topiramate group (p < 0.001, R2 = 0.32, 95% CI 0.22-0.37 and 0.42-0.91, respectively). Multivariate linear regression analysis revealed that the 2 most important predictors of accommodative lag were accommodation stimulus and age (p < 0.001, r = 0.51, 95% CI 0.31-0.32 and 0.67-0.69, respectively) CONCLUSIONS: Even after adjustment for age, accommodative lag is greater across several accommodative stimulus levels in patients using topiramate, which may be related to visual symptoms in topiramate users.
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Affiliation(s)
- Eren Çerman
- Marmara University School of Medicine, Department of Ophthalmology, Istanbul, Turkey.
| | - Semra Akkaya Turhan
- Marmara University School of Medicine, Department of Ophthalmology, Istanbul, Turkey
| | - Muhsin Eraslan
- Marmara University School of Medicine, Department of Ophthalmology, Istanbul, Turkey
| | | | - Özden Kilinç
- Marmara University School of Medicine, Department of Neurology, Istanbul, Turkey
| | - Tülin Tanrıdağ
- Marmara University School of Medicine, Department of Neurology, Istanbul, Turkey
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Silberstein SD. Topiramate in Migraine Prevention: A 2016 Perspective. Headache 2016; 57:165-178. [PMID: 27902848 DOI: 10.1111/head.12997] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 10/14/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND In evidence-based guidelines published in 2000, topiramate was a third-tier migraine preventive with no scientific evidence of efficacy; recommendation for its use reflected consensus opinion and clinical experience. Its neurostabilizing activity, coupled with its favorable weight profile, made topiramate an attractive alternative to other migraine preventives that caused weight gain. When guidelines for migraine prevention in episodic migraine were published in 2012, topiramate was included as a first-line option based on double-blind, randomized controlled trials involving nearly 3000 patients. The scientific and clinical interest in topiramate has generated a large body of data from randomized controlled trials, meta-analyses, patient registries, cohort studies, and claims data analyses that have more fully characterized its role as a migraine preventive. AIM This article will review the profile of topiramate that has emerged out of the past decade of research and clinical use in migraine prophylaxis. It will also address the rationale for extended-release (XR) formulations in optimizing topiramate therapy in migraine. SUMMARY Topiramate has activity at multiple molecular targets, which may account for why it is effective in migraine and most other, more specific, anticonvulsants are not. Based on randomized controlled trials, topiramate reduces migraine frequency and acute medication use, improves quality of life, and reduces disability in patients with episodic migraine and in those with chronic migraine with or without medication overuse headache. Its efficacy in chronic migraine is not improved by the addition of propranolol. Topiramate's ability to prevent progression from high-frequency episodic migraine to chronic migraine remains unclear. Consistent with clinicians' perceptions, migraineurs are more sensitive to topiramate-associated side effects than patients with epilepsy. Paresthesia is a common occurrence early in treatment but is rarely cause for terminating topiramate treatment. Cognitive problems occur much less frequently than paresthesia but are more troublesome in terms of treatment discontinuation. Cognitive complaints can often be managed by slowly increasing the topiramate dose in small increments to allow habituation. As with other carbonic anhydrase inhibitors, topiramate has metabolic effects that favor the development of metabolic acidosis and possibly renal stones. Because migraineurs have an increased risk of renal stones independent of topiramate exposure, clinicians should counsel all migraine patients to maintain hydration. Abrupt onset of blurring, other visual disturbances, and/or ocular pain following topiramate's initiation should be evaluated promptly since this may indicate rare but potentially sight-threatening idiosyncratic events. Postmarketing evidence has shown that first-trimester exposure to topiramate monotherapy is associated with increased occurrence of cleft lip with or without cleft palate (Pregnancy Category D). Even though topiramate's long half-life would seemingly support q.d. dosing, randomized controlled migraine trials used b.i.d. administration of immediate-release (IR) topiramate, which has more favorable plasma concentration-time profile (ie, lower peak concentrations and higher trough concentrations) than q.d. IR dosing. Given the sensitivity of migraineurs to topiramate-related adverse events, particularly cognitive effects, pharmacokinetic profiles should be considered when optimizing migraine outcomes. The extended-release (XR) formulations Qudexy® XR (Upsher-Smith Laboratories) and Trokendi XR® (Supernus Pharmaceuticals) were specifically designed to achieve the adherence benefits of q.d. dosing but with more favorable (ie, more constant) steady-state plasma concentrations over the 24-hour dosing interval vs IR topiramate b.i.d. Intriguing results from a study in healthy volunteers showed consistently less impairment in neuropsychometric tests of verbal fluency and mental processing speed with an XR topiramate formulation (Trokendi XR) vs IR topiramate b.i.d. These findings suggest a pharmacodynamic effect associated with significantly reducing plasma concentration fluctuation when topiramate absorption is slowed. Results of retrospective studies in migraineurs treated with XR topiramate appear to support a clinically meaningful benefit of XR topiramate vs IR topiramate in terms of significantly fewer cognitive effects, improved adherence, and overall better outcomes of migraine prophylaxis with topiramate.
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Affiliation(s)
- Stephen D Silberstein
- Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, 19107, USA
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Halpern B, Mancini MC. Safety assessment of combination therapies in the treatment of obesity: focus on naltrexone/bupropion extended release and phentermine-topiramate extended release. Expert Opin Drug Saf 2016; 16:27-39. [DOI: 10.1080/14740338.2017.1247807] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Bruno Halpern
- Obesity Unit, Department of Endocrinology, Hospital das Clínicas, University of São Paulo (USP), São Paulo, Brazil
| | - Marcio C. Mancini
- Obesity Unit, Department of Endocrinology, Hospital das Clínicas, University of São Paulo (USP), São Paulo, Brazil
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Goldberg JL, Lau AG, Fan B, Ford L, Greenberg HE. Is uveitis associated with topiramate use? A cumulative review. Clin Ophthalmol 2016; 10:1467-70. [PMID: 27536060 PMCID: PMC4977106 DOI: 10.2147/opth.s104847] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Occasional reports of uveitis following topiramate use necessitated an investigation of relevant cases from safety databases and published biomedical literature. Data mining of the Food and Drug Administration Adverse Event Reporting System and cumulative review of cases from the global safety database (sponsor database) and published literature were conducted to assess association between topiramate use and uveitis. The Food and Drug Administration Adverse Event Reporting System search identified disproportional reporting of uveitis (n=23) and related terms (choroidal detachment, n=25; iridocyclitis, n=17). The postmarketing reporting frequency of uveitis and related events from the global safety database and based on an estimated topiramate exposure of 11,185,740 person-years from launch to April 2015 was 0.38 per 100,000 person-years and assigned as very rare. A total of 14 potential uveitis cases were identified from the cumulative review. Seven of these 14 cases were complicated by inadequate documentation, appearance of uveitic signs following drug withdrawal, or concurrent use of other sulfonamides. In acute angle-closure glaucoma and uveal effusions cases, insufficient evidence for underlying inflammation suggested that uveitis was not a component. Only seven of 14 cases were well documented, potentially topiramate-associated uveitis cases. Uveitis may occur in the setting of topiramate use only in very rare instances. Current evidence did not reveal a dose- or duration-dependent relationship between uveitis and topiramate use.
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Affiliation(s)
| | - Amy G Lau
- Janssen Research & Development, LLC, Horsham, PA
| | - Bo Fan
- Janssen Research & Development, LLC, Horsham, PA
| | - Lisa Ford
- Janssen Research & Development, LLC, Titusville, NJ, USA
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Yeung TLM, Li PSH, Li KKW. Presumed topiramate retinopathy: a case report. J Med Case Rep 2016; 10:210. [PMID: 27480886 PMCID: PMC4968025 DOI: 10.1186/s13256-016-0980-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 06/13/2016] [Indexed: 11/30/2022] Open
Abstract
Background We report a case of peripheral pigmentary retinopathy and visual field loss following topiramate use for uncontrolled seizures. Such side effects have not been well documented despite the increasing use of topiramate in the past 10 years. A thorough search of available English literature revealed only a small number of reports of topiramate-induced retinopathy or visual field defects in humans. One similar case has been described. We are concerned about the possible rare instances of this occurrence in future patients and hence would like to propose a presumed correlation. Case presentation A 48-year-old Chinese woman developed blurred vision after 9 months of topiramate use. Her visual acuity dropped from 1.2 to 0.7 in both eyes, with bilateral diffuse pigmentary retinopathy and a constricted visual field. Despite an improvement in visual acuity after cessation of the drug, the other clinical findings remained. The temporal relationship between the initiation of topiramate and the visual disturbance suggests that topiramate could be the cause of such signs and symptoms. Conclusion Topiramate potentially causes pigmentary retinopathy and constricted visual field.
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Affiliation(s)
- Tiffany L M Yeung
- Department of Ophthalmology, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Kowloon, Hong Kong.,Department of Ophthalmology, Tseung Kwan O Hospital, 2 Po Ning Lane, Tseung Kwan O, Hong Kong.,Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Patrick S H Li
- Department of Ophthalmology, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Kowloon, Hong Kong.,Department of Ophthalmology, Tseung Kwan O Hospital, 2 Po Ning Lane, Tseung Kwan O, Hong Kong.,Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Kenneth K W Li
- Department of Ophthalmology, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Kowloon, Hong Kong. .,Department of Ophthalmology, Tseung Kwan O Hospital, 2 Po Ning Lane, Tseung Kwan O, Hong Kong. .,Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong.
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Topiramate-Induced Persistent Eyelid Myokymia. Case Rep Psychiatry 2016; 2016:7901085. [PMID: 27293943 PMCID: PMC4886081 DOI: 10.1155/2016/7901085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 05/04/2016] [Indexed: 11/17/2022] Open
Abstract
Background. Topiramate (TPM) is a psychotropic drug, which is used mainly as an antiepileptic drug and now over the years is used for a wider range of indications, including migraine prophylaxis and binge eating disorders. Although ocular side effects of Topiramate have been frequently reported, neuroophthalmologic manifestations such as myokymia are rarely reported. Case Presentation. This case report presents a case of a 47-year-old woman who had begun TPM for binge eating problem. She developed unilateral long standing lower eyelid twitching, which progressed to upper eyelid and eyebrow at the same side. The patient was not a smoker or excessive alcohol or caffeine abuser. Increasing the resting time and changing life style made no significant changes in her eyelid twitching. There was no definite evidence by neuroimaging and clinical or laboratory evaluations causing eyelid myokymia. The symptoms resolved with discontinuation of TPM. Conclusion. Although eyelid myokymia is a benign and self-limited condition, it sometimes becomes a source of distress in chronic long standing cases. Physicians should be aware of the neuroophthalmologic side effects of this drug.
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Abstract
PURPOSE We performed a literature synthesis to identify the full spectrum of compounds implicated in drug-induced, bilateral secondary angle-closure glaucoma (2° ACG). METHODS Systematic PubMed literature review identified relevant bilateral 2° ACG case reports. We evaluated these reports with both the Naranjo adverse drug reaction probability scale to assess the causality of reported drug reactions and a 2° ACG scale scoring system we developed to determine the likelihood that the event represented bilateral 2° ACG. Two independent graders performed these analyses and their scores were averaged for interpretation. The Naranjo scale ranges from -4 to +13 and the drug reaction was considered definite if the score was ≥ 9, probable if 5 to 8, possible if 1 to 4, and doubtful if ≤ 0. The 2° ACG score ranges from 0 to 7. We considered a 2° ACG score of ≥ 4 as evidence of significant likelihood that the drug reaction represented bilateral 2° ACG. RESULTS No drug had a definite Naranjo score, but the following drug entities had probable Naranjo scores and 2° ACG scores ≥ 4: acetazolamide, "anorexiant mix," bupropion, cabergoline, "ecstasy," escitalopram, flavoxate, flucloxacillin, hydrochlorothiazide, hydrochlorothiazide/triamterene, mefenamic acid, methazolamide, oseltamivir, topiramate, topiramate/bactrim, and venlafaxine. Root chemical analysis revealed that sulfur-containing and non-sulfur-containing compounds contributed to bilateral 2° ACG. CONCLUSIONS Several compound preparations were implicated in drug-induced bilateral 2° ACG. Treating physicians should be aware that some forms of recreational drug use, which the patient may not admit to, could contribute to this vision-threatening side effect.
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Haque S, Shaffi M, Tang KC. Topiramate associated non-glaucomatous visual field defects. J Clin Neurosci 2016; 31:210-3. [PMID: 27229356 DOI: 10.1016/j.jocn.2016.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 03/03/2016] [Accepted: 03/08/2016] [Indexed: 11/19/2022]
Abstract
We report a 34-years-old woman who presented with bilateral incongruous inferior visual field defects after the commencement of topiramate for management of migraine. Investigations did not reveal any underlying angle closure glaucoma, reported in current literature to be associated commonly with topiramate associated visual field defects. The changes in the peripheral visual fields gradually improved over several months after the medication was withdrawn. There were only minor changes persistent on the left side on a background of pre-existing myopia and keratoconus. Visual field deficits secondary to topiramate are more commonly attributed to angle closure glaucoma due to ciliochoroidal effusion syndrome. In such instance, the visual field defects are associated with considerable pain due to raised intra-ocular pressure. There have also been reports of visual scotomas due to retinal damage and maculopathy in patients taking topiramate. It is worthwhile to obtain a baseline perimetry in patients being considered for topiramate therapy in order to gauge any changes in their peripheral field of vision during the treatment. Changes in visual fields during the course of medication use and after cessation can be easily compared especially if there are other possible confounders such as refractive errors or a history of migraine.
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Affiliation(s)
- Sameen Haque
- Neurology Department, Canberra Hospital, Yamba Dr, Garran, ACT 2605, Australia.
| | - Mohamed Shaffi
- Neurology Department, Nepean Hospital, Derby St, Kingswood, NSW 2747, Australia
| | - Kong C Tang
- Midwest Ophthalmology, Orange, NSW 2800, Australia
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Man X, Costa R, Ayres BM, Moroi SE. Acetazolamide-Induced Bilateral Ciliochoroidal Effusion Syndrome in Plateau Iris Configuration. Am J Ophthalmol Case Rep 2016; 3:14-17. [PMID: 29226268 PMCID: PMC5718619 DOI: 10.1016/j.ajoc.2016.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose Our purpose is to describe a 60-year-old male, who has plateau iris configuration and developed bilateral ciliochoroidal effusion syndrome after ingestion of acetazolamide. Observations Our case was a research participant in a multi-center clinical study (ClinicalTrials.gov NCT01677507). During the course of this study, he was treated with a single dose of acetazolamide (500 mg), and seven days later treated with latanoprost one drop daily at bedtime both eyes for seven days, and then was administered another dose of acetazolamide (500 mg). Several hours later he complained of blurred vision in the distance and mild headache. On examination, he had a myopic shift, intraocular pressures of 36 mmHg in right eye and 35 mmHg in left eye, shallow anterior chambers both eyes, and occluded angles by gonioscopy both eyes. An echographic exam confirmed the bilateral ciliochoroidal effusion syndrome. He was treated by no further dosing of acetazolamide and started on timolol, atropine and prednisolone. Two weeks later, the bilateral choroidal effusion and acute angle closure were resolved. Repeat echography showed plateau iris configuration. Conclusions and Importance To the best of our knowledge, drug-induced bilateral ciliochoroidal effusion syndrome has not been reported with acetazolamide in plateau iris configuration.
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Affiliation(s)
- Xiaofei Man
- 1000 Wall St., Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI.,1665 Kong Jiang Road, Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Raquel Costa
- 1000 Wall St., Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI.,Rua Cônego, 315 apto 202. Centro. Patos de Minas, MG. Brazil. Zip code: 38700-150. Oftall Clínica de Olhos
| | - Bernadete M Ayres
- 1000 Wall St., Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI
| | - Sayoko E Moroi
- 1000 Wall St., Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI
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Abstract
BACKGROUND Migraine is a chronic debilitating disorder. Selected antiepileptic drugs (AEDs) are proposed as preventives for migraine. Clinical efficacy and side effects of these AEDs are discussed. SUMMARY OF REVIEW The American Academy of Neurology and the American Society of Headache classify topiramate (TPM) and divalproex sodium (DVPX) as Level-A medications and recommend offering them to patients for migraine prophylaxis. Their mechanism(s) of actions remains not entirely known. Their recognized action as sodium channel blockers may affect the neural component of migraine pain. TPM or DVPX can be considered an obvious choice for those patients with a concomitant seizure disorder. Care must be taken to plan their treatment with their psychiatrist if a mood disorder is present. DVPX tends not to be prescribed as first/second choice due to its potential for weight gain and hepatotoxicity. TPM is generally first choice, but bears severe contraindications. Both medications require education on teratogenesis in childbearing women. Consideration of gabapentin, acetazolamide, leviteracetam, zonisamide, and carbamazipine may be given later as empiric options and in selected patients. Patients must be made aware that there is insufficient scientific support for their use in migraine. CONCLUSIONS Available AEDs to prophylactically treat migraine are few but of robust clinical efficacy. Special care needs to be exerted with respect to their side effects. Future research is needed for a better understanding of their mechanisms of action in migraine. Such research has the potential of providing some insight into the pathophysiology of migraine.
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Affiliation(s)
| | - Janine Good
- Department of Neurology, University of Vanderbilt, Nashville, TN, USA
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Hesami O, Hosseini SS, Kazemi N, Hosseini-Zijoud SM, Moghaddam NB, Assarzadegan F, Mokhtari S, Fakhraee S. Evaluation of Ocular Side Effects in the Patients on Topiramate Therapy for Control of Migrainous Headache. J Clin Diagn Res 2016; 10:NC01-4. [PMID: 27134906 DOI: 10.7860/jcdr/2016/16263.7339] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 11/19/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Topiramate, a sulfa-derivative monosaccharide, is an antiepileptic drug which is administered in the control of migraine. It is reported to cause various ocular side effects such as visual field defect and myopic shift. To investigate the alterations in refractive error, properties of the cornea and changes in the anterior chamber in patients that receive Topiramate for migraine control. MATERIALS AND METHODS This is a hospital-based, non-interventional, observational study that is conducted at Imam Hossein Hospital, affiliated to Shahid Beheshti University of Medical Sciences, Department of Neurology, in collaboration with the department of Ophthalmology. Thirty three consecutive patients with the diagnosis of migraine that were candidate for Topiramate therapy were recruited. Patients with history of ocular trauma or surgery, keratoconus, glaucoma, congenital ocular malformations and any history of unexplained visual loss were excluded. After thorough ophthalmic examination, all the patients underwent central corneal thickness (CCT) measurement, and Pentacam imaging (Scheimpflug camera) at the baseline. Various parameters were extracted and used for analysis. Anterior chamber volume (ACV), anterior chamber depth (ACD), and anterior chamber angle (ACA) measurement was performed. These measurements were repeated on day 30(th) and 90(th) after the initiation of Topiramate therapy. According to the normality tests, parameters with normal distribution were analysed using the repeated measures test and the remaining parameters (with non-normal distribution) were analysed using the non-parametric k-sample test. A p-value< 0.05 was considered statistically significant, according to Bonferroni post hoc correction. RESULTS There were 66 eyes of 33 patients under the diagnosis of migrainous headache, that Topiramate was initiated for headache control, included in the study. The mean value of refractive error had a statistically significant myopic change, from -0.23 diopters (D) at the baseline to -0.61 D at the 90(th) day of follow-up period (p-value < 0.001). Mean CCT was 531.43 μm at the baseline and increased to 534.72 μm at the 30(th) day, and 537.51 μm at the 90(th) day after the administration of Topiramate (p-value=0.001). Mean value of other parameters, ACV, ACD, and ACA, did not reveal statistically significant change. CONCLUSION Myopic shift and gradually increasing CCT in the patients after Topiramate administration should be considered before any refractive surgery. We found no gradual change in the anterior chamber and angle parameters in our patients in the 90 days of follow up. More studies with a longer duration of follow-up are needed to elucidate dose-dependent ocular manifestations.
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Affiliation(s)
- Omid Hesami
- Assistant Professor, Department of Neurology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences (SBMU) , Tehran, Iran
| | | | - Nasim Kazemi
- Neurologist, Dezful University of Medical Sciences , Dezful, Iran
| | - Seyed-Mostafa Hosseini-Zijoud
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences , Kermanshah, Iran
| | - Nahid Beladi Moghaddam
- Assistant Professor, Department of Neurology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences (SBMU) , Tehran, Iran
| | - Farhad Assarzadegan
- Assistant Professor, Department of Neurology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences (SBMU) , Tehran, Iran
| | - Sara Mokhtari
- Optometrist, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences (SBMU) , Tehran, Iran
| | - Shahrzad Fakhraee
- Assistant of Neurology, Department of Neurology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences (SBMU) , Tehran, Iran
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Ikeda N, Ikeda T, Kohno T. Traumatic myopia secondary to ciliary spasm after blunt eye trauma and reconsideration of its pathogenesis. Graefes Arch Clin Exp Ophthalmol 2016; 254:1411-7. [PMID: 26860527 DOI: 10.1007/s00417-016-3282-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 01/19/2016] [Accepted: 01/25/2016] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To reconsider the pathogenesis of traumatic myopia by describing two cases and literature review. METHODS Refraction was measured, A-scan ultrasonography was performed, and ultrasound biomicroscopy (UBM) was used to observe the ciliary body in the acute and recovery stages. RESULTS The first patient had a myopic shift of -6.12 diopters (D) on the initial examination (day 2) compared with the recovered stage. UBM showed ciliochoroidal effusion in one half of the circumference and severe edema in three eighths of the ciliary body, which led to an anterior rotation of the ciliary body. Immediately after the cycloplegia, the myopic shift decreased by -3.9 D. On day 11, the refraction was -0.63 D, and the UBM findings were normalized. The second patient had a myopic shift of -4.38 D on the first examination compared with the recovered stage. UBM showed an annular ciliochoroidal effusion leading to anterior rotation of the ciliary body. Immediately after the cycloplegia, there was a decrease of -2.75 D. Biometric measurements showed an increased anterior chamber depth and a decreased thickness of the lens. On day 16, the refraction was -1.0 D, and the UBM findings were normalized. In both cases, biometric measurements in the acute phase suggested a anterior chamber shallowing, a thickening of the lens, and an anterior shift of the lens-iris diaphragm CONCLUSIONS Cycloplegia decreased the myopic shift by more than 60 %. These findings indicate a significant contribution of ciliary spasm combined with ciliochoroidal effusion, anterior shift of the lens-iris diaphragm, and thickening of the lens.
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Affiliation(s)
- Naohiro Ikeda
- Department of Ophthalmology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya-shi, Hyogo, 663-8501, Japan.
| | - Tomohiro Ikeda
- Department of Ophthalmology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya-shi, Hyogo, 663-8501, Japan
| | - Takeya Kohno
- Department of Ophthalmology and Visual Science, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
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Response to ‘Comment on Topiramate maculopathy secondary to dose titration: first reported case’. Eye (Lond) 2016; 30:166. [DOI: 10.1038/eye.2015.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Chang KH, Wang SH, Chi CC. Efficacy and Safety of Topiramate for Essential Tremor: A Meta-Analysis of Randomized Controlled Trials. Medicine (Baltimore) 2015; 94:e1809. [PMID: 26512577 PMCID: PMC4985391 DOI: 10.1097/md.0000000000001809] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Essential tremor (ET) is the most common movement disorder that is frequently treated by propranolol or primidone. However, 30% of patients with ET do not respond to either propranolol or primidone. The objective of this study was to assess the efficacy and safety of topiramate for ET.We searched the MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials for relevant randomized controlled trials on the effects of topiramate for ET. A meta-analysis technique was applied to estimate the efficacy and safety of topiramate. The primary outcome was the change in the Fahn-Tolosa-Marin tremor rating scale (TRS). The secondary outcomes included the respective change in the location, motor tasks/function and function disability scores, and adverse events.We included 3 randomized controlled trials with a total of 294 participants. Topiramate was significantly better than placebo in reducing TRS of patients with ET (mean difference [MD] -8.58, 95% confidence interval [CI] -15.46 to -1.70). Changes from the scales of upper limb tremor severity (MD -5.12, 95% CI -7.79 to -2.45), motor tasks/function (MD -5.07, 95% CI -7.12 to -3.03), and functional disability (MD -4.72, 95% CI -6.77 to -2.67) were significantly greater with topiramate than with placebo. More participants taking topiramate experienced adverse events leading to withdrawal than those taking placebo (risk difference 19%, 95% CI 11%-27%).There is consistent evidence supporting the efficacy of topiramate in treating ET; however, a significant proportion of participants withdrew due to its adverse effects.
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Affiliation(s)
- Kuo-Hsuan Chang
- From the College of Medicine, Chang Gung University (K-HC, C-CC); Department of Neurology, Chang Gung Memorial Hospital, Linkou, Taoyuan (K-HC); Department of Dermatology, Far Eastern Memorial Hospital, New Taipei (S-HW); and Centre for Evidence-Based Medicine and Department of Dermatology, Chang Gung Memorial Hospital, Chiayi, Taiwan (C-CC)
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