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S. R. Shareef, S. S. Awadalla; A Preliminary Study: How Real Is the Risk for Developing Drug Induced Angle Closure Glaucoma?. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4346.
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(1) To determine prevalence of drug induced secondary angle closure glaucoma (sACG) from public consumption. (2) To assess statistical significance of risk for developing sACG by taking such medications.
Literature Search using PubMed (1966 to present) conducted to identify all sACG publications. Drug warning label using the term ‘glaucoma’ was ascertained for each drug using UpToDate Online Search Engine at http://www.utdol.com/utd/index.do. Reports were divided into 3 categories: Chemically induced ACG among the public (Group A; n=126); General anesthesia induced ACG (Group B; n =10); non-drug induced ACG (Group C; n=57). Intra-ocular surgical (iatrogenic) ACG reports were excluded. In Groups A and B, drugs were categorized by class; Group C, by etiology. In Group A, the proportions of the most prevalent drug classes were compared to overall population proportions of written prescriptions of the top 200 drugs in 2003.
The prevalence of drug-induced ACG (Group A) was 65.3% [CI = (58.1%, 72.0%)], general anesthesia (Group B) (5.2%) [CI = (2.5%, 9.3%)], and non-drug induced (Group C) (29.5%) [CI = 23.2%, 36.5%]. Within Group A, the most frequent drug classes were Anti-seizure (73.8%) [CI = (65.2%, 81.2%)], Anti-depressant (10.3%) [CI = (5.6%, 17.0%)] and Bronchodilators (6.3%) [CI = (2.8%; 12.1%)]. In Group C, vascular etiology (56.1%) [CI = (42.4%, 69.3%)] was most common. Drug-induced [Groups A, B] had a female preponderance and bilateral ACG. A two-proportion test for the top 3 drugs for each class showed that only the Anti-seizure drug Topamax had an increased proportion of 64% [CI = (56.8%, 72.1%)] as compared to Anti-depressant drug Paxil and Bronchodilator drug Albuterol.
In 4 decades, the most prevalent published risk factor for sACG was drug-induced [Group A (65.3%)] among the public that consumes such medications. Anti-seizure, Anti-depressant and Bronchodilators respectively were the most frequent drug class reported. However, within this class, only Topamax showed a significantly high proportion of risk for sACG compared to the overall population proportions of written prescriptions in 2003. A bilateral presentation of ACG should prompt physicians to take a good medical history to rule out a drug-induced etiology and to warn patients of this risk prior to prescribing topiramate.
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