Topiramate-induced ocular complications: case series.

Several ocular adverse effects have been attributed to Topiramate, a sulfonamide derivative. It can cause problems in the eye such as choroidal effusion syndrome, acute angle closure glaucoma, myopic shift, visual field defects, and Myokymia. If not identified early, it can be vision-threatening. It is commonly used for migraine prophylaxis, partial onset, and generalized tonic-clonic seizures. It has also been prescribed for bipolar disorder and alcoholism. The risk of adverse reactions with this drug is 3%. The prognosis is favorable if it is discontinued early and prompt therapy is initiated. OBJECTIVE: This article reported a case series of topiramate-induced ocular complications. MATERIALS AND METHODS: The patients presented with high intraocular pressure and blurred vision following a topiramate prescription for headache. CONCLUSION: Timely recognition and intervention can prevent potential visual loss in such cases.

Postoperative CSF Leak: Blood Patch-A New Avenue.

Introduction Cerebrospinal fluid leak (CSF) after a neurosurgical procedure is a known complication that may result in bad outcomes (1). The incidence of CSF leak varies based on the site involved; it ranges from 4 to 32% for transsphenoidal to posterior fossa procedures. The costs involved in treating postoperative CSF leaks increases exponentially that becomes a barrier in continuing optimum treatment. There are many studies that compare the different treatment modalities and even use of sealing agents but none give an algorithm of management. Our study aims at known technique that can help to treat these kinds of low-pressure CSF leaks. Materials and Methods This was a prospective study done over a period of 5 years from January 2014 to January 2019. All patients who underwent procedures in which durotomy was done were included in the study. Results A total of six patients were enrolled for the study. The duration of the study spanned 5 years from January 2014 to January 2019. All the patients after taking informed consent underwent the necessary investigations and a blood patch was done. Five of the patients the CSF stopped but in one patient it persisted. This patient again underwent investigation and under image guidance another blood patch was put after which the CSF leak stopped. Conclusion Blood patch under imaging guidance is a safe and simple technique. The success rates of cessation of CSF leaks are good. Also, it is a cost-effective method using an autograft (patient's blood).

Comparing proximal convergence ratio in myopes.

Aim: To determine if there is a difference at all in proximal convergence to accommodation ratio (PC/ A) between 2 myopic groups. Group A: -0.50D < SE < 3.00D, SE: spherical equivalent, D: Diopter) and Group B (-3.00D SE and above). Patients and methods: In this prospective observational study, 24 consecutive patients with myopia between -0.50D < SE < 3.00D were included in group A and 27 consecutive patients with myopia > -3.00 D SE were included in group B. Patients with pathological myopia, strabismus or heterophoria anomalies were excluded. The PC/ A ratio for both the groups were calculated by measuring the difference between value of accommodative convergence to accommodation ratio (AC/ A) derived from heterophoria and gradient method using a prism bar method. Statistical analysis was performed by analyzing descriptive statistics and the independent sample t-test using SPSS ver. 22.0 software. Results: The average calculated PC/ A ratio was 3.24∆/ D (SD = +0.68/ D) in group B (n=27) and 2.6∆/ D (SD = 0.86/ D) in group A (n=24) (p value <0.05). Conclusion: An evident high AC/ A ratio in group B patients with myopia more than -3.00 D was the predominant cause for high PC/ A ratio in group B patients.