Publication: Changes of retinal nerve fiber layer thickness, macular thickness and choroidal thickness in migraine patients on topiramate
Date
2022
Authors
Suparmaniam, Sruban
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Introduction: Migraine is a common primary headache disorder and is ranked as the world's second leading cause of years lived with disability. It is a neurovascular disorder believed to cause altered and permanent structural abnormalities to the optic nerve, retina, and choroid. Topiramate (TPM) is a sulfa-derivative monosaccharide that is effective as a preventive therapy for migraine. TPM may impair retinal function when administered for long periods. Retinal nerve fiber layer (RNFL) thickness measurement can be used as an index to assess ganglion cell and retinal nerve fiber damages while alteration of macular thickness (MT) and choroidal thickness (CT) values due to decreased blood flow in migraine with the usage of TPM can affect the visual functions. Objectives: The aim of this study is to assess changes in RNFL thickness, MT, and CT in migraine patients on topiramate (TPM). Methods: This cross-sectional study involves migraine patients with and without TPM attending the Neurology Clinic and Ophthalmology Clinic at Hospital USM and Hospital Raja Perempuan Zainab II (HRPZ II) Kota Bharu, Kelantan. The RNFL thickness, MT, CT was measured using Cirrus HD-OCT 5000 and statistical analysis was done using SPSS Inc Version 26. Results: A total of 84 migraine patients (42 patients with TPM and 42 patients without TPM) were recruited into the study and were analysed. With respect to all mean values of RNFL thickness and MT in all quadrants, there were no statistically significant differences in migraine patients with TPM and control. For subfoveal CT, there was a significant increase with adjustment of age and gender (adjusted mean 272.26μm; 95% CI = 263.73, 280.80 vs 288.14μm; 95% CI = 279.60, 296.68; p = 0.011). Conclusion: This study showed no significant differences between RNFL thickness and MT in migraine patients with and without TPM. Compared to control, there was a significant increase in central subfoveal CT in migraine patients with TPM. The CT measurement during the use of TPM in migraine patients can be considered as a potential non-invasive follow-up method in asymptomatic patients.
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