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概要

Topiramate and Triptan Concomitant use in Acute Angle Closure Glaucoma

Shivam Gulhar, Christian Mays, Surbhi Bansal

Background: We present a case of severe bilateral angle closure crisis in a patient using both topiramate and triptans with intraocular pressures that were refractory to initial medical therapy. We explore the mechanism of acute angle closure and additional factors that may be contributing to this specific presentation.

Case: In this case report, we present our clinical findings, review the mechanism of action of acute angle closure glaucoma, and explore well studied as well as theoretical treatments. We will review current literature citing topiramate induced acute angle closure glaucoma, sumatriptan acute angle closure glaucoma and investigate the possibility of a synergistic relationship between these medications as well as other sulfa based drugs.

Results: The literature suggests a well-known mechanism of angle closure induced by topiramate and sulfa drugs with the development of choroidal effusion causing anterior rotation of ciliary body, along with the lens-iris diaphragm, which leads to the closure of the angle. There is minimal literature on concomitant use of topiramate and triptans with an unknown synergistic relationship between these sulfa based medications. Additional literature review suggests a role of inflammation of the ciliary body in the closure of the angle. We treated our patient with an additional sulfabased drug acetazolamide and then steroids that improved her intraocular pressures and angle anatomy.

Conclusion: There is no known synergism between topiramate and triptan medications in acute angle closure, but the presentation, severity, and progression of acute angle closure with resistance to initial treatment in our patient may suggest a possible synergistic mechanism. The use of corticosteroids in topiramate or triptan induced acute angle closure may be indicated in the setting of the speculative role inflammation plays in angle closure.