Sir,

We agree with Kozner et al that the maculopathy reported in our case1 likely represents a mild form of the idiosyncratic reaction causing choroidal effusion, induced myopia, and angle-closure glaucoma that has been reported with topiramate and other sulfur-containing medications. In these cases, it is a consistently reported feature that the reaction generally occurs within days following commencement of the drug or an increase in dose.2 In Kosner’s case,3 the reaction occurred 3 days after discontinuing topiramate and a sulfur-containing antibiotic, but the patient had commenced the medication 10 days prior to presentation. It is therefore difficult to be sure of the precise trigger in this case.

The important clinical point is that discontinuation of the drug leads to resolution of the symptoms. In some reports, resolution has possibly been hastened following the administration of IV methylprednisolone.2, 3