偏頭痛患者使用Topiramate引起兩眼急性隅角閉鎖型青光眼及急性近視性變化－病例報告

目的：描述一位偏頭痛患者在服用Topiramate後引起雙眼急性青光眼發作及近視度數急遽加深之案例。方法：病例報告。結果：一名四十一歲女性患者主訴雙眼視力突然間模糊、脹痛感並伴隨著頭痛。她本身有偏頭痛病史，除了右眼近視兩百二十五度，左眼近視一百七十五度外，並無眼科相關疾病。以Snellen視力表測得戴眼鏡之視力右眼為零點一，左眼為零點四。電腦驗光顯示兩眼近視度數皆急遽增加三百度，但雙眼測得最佳矯正視力皆可達到壹點零，右眼眼壓高達44 毫米汞柱，而左眼為49毫米汞柱。裂隙燈及隅角鏡檢查顯示隅角閉鎖型青光眼。以B-scan超音波及Ultrasound biomicroscopy（UBM）超高頻生物顯微鏡檢查可觀察到脈絡膜上積液情形和呈現水腫狀之睫狀體。視神經及視野檢查結果皆呈現正常。病患本身沒有青光眼病史，亦無青光眼家族史。仔細詢問其病史，得知神經內科醫師在一個禮拜前將偏頭痛藥物改為Topiramate （25mg twice daily），而服用該藥物滿一星期之後出現眼睛不適症狀，於是被診斷為藥物造成之次發性急性青光眼。我們立刻建議病患停用Topiramate，並給予降眼壓藥物，包括Mannitol靜脈注射及降眼壓眼藥水和散瞳劑治療。兩天後，眼壓回復到正常範圍。而近視情況也在一個星期後回復到原來度數，且戴眼鏡時兩眼視力皆可達到壹點零。脈絡膜上積液情況也在治療三個禮拜後大幅改善。結論：這個案例顯示服用Topiramate可能造成急性近視及次發性隅角閉鎖型青光眼。眼科醫師應該瞭解這個潛在併發症，儘早診斷並給予適當的治療措施，以免導致嚴重的後遺症包括永久性失明。

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並列摘要

Purpose: To describe a migraine patient receiving topiramate and developed bilateral acute angle-closure glaucoma and myopic shift.Method: Case report.Result: A 41-year-old female with a migraine history had no previous ocular problems except myopia with spherical refraction of -2.25D OD and -1.75D OS. She experienced sudden onset of bilateral blurred vision, a sensation of fullness and a headache after 7 days of topiramate therapy (50mg/day). Her visual acuities with presenting glasses were 20/200 OD and 20/50 OS. Intraocular pressures (IOP) were 44 mmHg OD and 49 mmHg OS respectively. Autorefraction measurement showed spherical refraction of -5.25D OD and -4.75D OS. Best-corrected visual acuity was 20/20 in both eyes. Slit-lamp examination revealed bilateral conjunctival chemosis, very shallow anterior chambers (2.20 mm OU), forward displacement of lens-iris diaphragm, round and sluggishly reacting pupils and closed angles on gonioscopy. B-scan ultrasound displayed choroidal thickening in both eyes. An ultrasound biomicroscopy (UBM) demonstrated bilateral 360 degree ciliochoroidal effusions with forward rotation of ciliary body but no pupillary block. She was advised to discontinue topiramate immediately and was started on anti-glaucoma medication and mydriatics. Two days later, IOP returned to normal limits and myopic shift resolved after one week. Her visual acuity with her previous glasses improved to 20/20 OU. Choroidal effusions subsided gradually as well. However, relative shallow anterior chamber depth was noted during a 3-month follow-up (2.68 mm OD and 2.62 mm OS).Conclusion: Topiramate/sulfa-derivative medications can induce rare and severe ocular complications with bilateral acute myopia and angle-closure glaucoma secondary to choroidal effusions. Neurologists and psychiatrists prescribing topiramate for their patients should be alert to such adverse effects and appropriate referral is encouraged on clinical suspicion. Ophthalmologists must examine such patients carefully and review their medical history thoroughly. The quick identification of sulfa-derivative medications and subsequent discontinuation can expedite resolution of the angle closure. Otherwise, this condition could result in permanent visual loss.

並列關鍵字

Topiramate ； angle-closure glaucoma ； myopic shift ； migraine

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偏頭痛患者使用Topiramate引起兩眼急性隅角閉鎖型青光眼及急性近視性變化－病例報告

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