Elevated intraocular pressure and myopic shift linked to topiramate use.

PURPOSE: The purpose of this report is to describe acute myopia as an ocular adverse reaction to topiramate (Topamax, Ortho-McNeil, Raritan, NJ) and discuss the importance of recognizing this syndrome. METHODS: Retrospective case report and brief review of the literature. RESULTS: A 27-year-old female patient developed decreased vision in both eyes due to acute myopia 2 weeks of after initiating therapy with topiramate. Emergency department evaluation revealed visual acuities of 20/400 right eye and 20/200 left eye. Intraocular pressures were 33 mm Hg right eye and 26 mm Hg left eye. The anterior chambers were shallow. Retinal striae were present in the maculae. The patient stated no previous need for optical correction. However, after initiating treatment with topiramate, she refracted to approximately -5.00 D bilaterally. Ultrasound testing revealed that the patient had suprachoroidal effusions in both eyes. The symptoms and clinical findings resolved completely with discontinuation of topiramate, administration of topical atropine 1% and prednisolone acetate 1%. CONCLUSIONS: An acute myopic shift may be the presenting sign of an idiosyncratic drug reaction that can include secondary bilateral angle closure glaucoma. This condition can occur in patients who do not have a history of anterior chamber abnormalities. Recognizing this condition and discontinuing the use of the causative drug may prevent angle closure and associated vision loss.

Purtscher-like retinopathy in a patient with HELLP syndrome.

PURPOSE: To report the antepartum presentation of Purtscher-like retinopathy and hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome that resulted in severe permanent visual loss. DESIGN: Interventional case report. METHODS: A 25-year-old primigravida patient at 38.5 weeks gestation presented with severe bilateral loss of vision. Immediate hospitalization with complete evaluation, urgent medical treatment, and cesarean section was performed. RESULTS: Ophthalmoscopic evaluation showed bilateral Purtscher-like retinopathy. Laboratory studies revealed elevated liver enzymes, thrombocytopenia, and evidence of intravascular coagulation consistent with HELLP syndrome. Despite the successful delivery of a healthy baby, the patient developed permanent visual loss. CONCLUSION: Purtscher-like retinopathy with permanent visual loss can occur antepartum in patients with HELLP syndrome.

Polypoidal choroidal vasculopathy.

BACKGROUND: Polypoidal choroidal vasculopathy (PCV) is a unique form of occult choroidal neovascular membrane. The clinical presentation and angiographic findings distinguish idiopathic PCV from other known neovascular and choroidal degenerative disorders. The characteristic morphology of PCV includes the presence of a branching network of inner choroidal vessels with terminal aneurysmal dilations. Other key findings include subtle nodular protrusions, which may precede multiple serosanguineous retinal pigment epithelial detachments. If Bruch's membrane is compromised, there is an additional risk of exudative retinopathy or vitreal hemorrhage. CASE REPORTS: Three patients with polypoidal choroidal vasculopathy are described with visual impairment secondary to irregular choroidal vascular lesions producing recurrent subretinal hemorrhages and exudative retinopathy. CONCLUSIONS: The characteristic presentation and clinical course of polypoidal choroidal vasculopathy distinguish it from the typical presentation of age-related macular degeneration and other causes of hemorrhagic and exudative retinopathy. Imaging techniques such as fluorescein angiography, indocyanine green angiography, and optical coherence tomography may assist in the accurate diagnosis of PCV, so that appropriate treatment and management can be provided. In patients who manifest exudative, hemorrhagic retinopathy, with no signs of active inflammation or an anatomic predisposition to choroidal neovascularization, PCV should be considered.