Document Detail

Rapid resolution of topiramate-induced angle-closure glaucoma with methylprednisolone and mannitol.
MedLine Citation:
PMID:  16765687     Owner:  NLM     Status:  MEDLINE    
PURPOSE: Topiramate-induced angle-closure glaucoma (TiACG) is believed to be related to its sulfonamide moiety. Although the exact mechanism is unknown, the time course and constellation of symptoms are consistent with a possible inflammatory pathophysiologic condition.
DESIGN: Interventional case report.
METHODS: We report the clinical outcome of a case of TiACG that was associated with an extreme intraocular pressure elevation of >60 mm Hg that was treated with the combination of systemic mannitol and methylprednisolone.
RESULTS: The combination of the two systemic medications resulted in the resolution of the attack with a much more rapid time course than is seen typically for extreme cases of TiACG. Mannitol treatment alone did not lower the intraocular pressure after 90 minutes, although improvement was noted four hours after methylprednisolone.
CONCLUSION: For severe cases of TiACG that are associated with very high intraocular pressures, the combination of mannitol and methylprednisolone can induce a rapid improvement. Inflammation may be a component of TiACG.
Douglas J Rhee; Jerome C Ramos-Esteban; Karen S Nipper
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  American journal of ophthalmology     Volume:  141     ISSN:  0002-9394     ISO Abbreviation:  Am. J. Ophthalmol.     Publication Date:  2006 Jun 
Date Detail:
Created Date:  2006-06-12     Completed Date:  2006-07-06     Revised Date:  2013-08-21    
Medline Journal Info:
Nlm Unique ID:  0370500     Medline TA:  Am J Ophthalmol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1133-4     Citation Subset:  AIM; IM    
William and Anna Goldberg Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.
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MeSH Terms
Anterior Eye Segment / ultrasonography
Diuretics, Osmotic / therapeutic use*
Drug Therapy, Combination
Fructose / adverse effects,  analogs & derivatives*
Glaucoma, Angle-Closure / chemically induced*,  drug therapy*,  ultrasonography
Glucocorticoids / therapeutic use*
Intraocular Pressure / drug effects
Mannitol / therapeutic use*
Methylprednisolone / therapeutic use*
Microscopy, Acoustic
Visual Acuity / drug effects
Reg. No./Substance:
0/Diuretics, Osmotic; 0/Glucocorticoids; 0H73WJJ391/topiramate; 30237-26-4/Fructose; 69-65-8/Mannitol; 83-43-2/Methylprednisolone

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