Rapid resolution of topiramate-induced angle-closure glaucoma with methylprednisolone and mannitol

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.