Peripapillary Retinal Pigment Epithelium Layer Shape Changes From Acetazolamide Treatment in the Idiopathic Intracranial Hypertension Treatment Trial

Jui-Kai Wang; Randy H Kardon; Johannes Ledolter; Patrick A Sibony; Mark J Kupersmith; Mona K Garvin; OCT Sub-Study Committee and the NORDIC Idiopathic Intracranial Hypertension Study Group

doi:10.1167/iovs.16-21089

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Peripapillary Retinal Pigment Epithelium Layer Shape Changes From Acetazolamide Treatment in the Idiopathic Intracranial Hypertension Treatment Trial

Journal article

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Peripapillary Retinal Pigment Epithelium Layer Shape Changes From Acetazolamide Treatment in the Idiopathic Intracranial Hypertension Treatment Trial

Jui-Kai Wang, Randy H Kardon, Johannes Ledolter, Patrick A Sibony, Mark J Kupersmith, Mona K Garvin and OCT Sub-Study Committee and the NORDIC Idiopathic Intracranial Hypertension Study Group

Investigative ophthalmology & visual science, Vol.58(5), pp.2554-2565

05/01/2017

DOI: 10.1167/iovs.16-21089

PMCID: PMC5425231

PMID: 28492874

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Abstract

Recent studies indicate that the amount of deformation of the peripapillary retinal pigment epithelium and Bruch's membrane (pRPE/BM) toward or away from the vitreous may reflect acute changes in cerebrospinal fluid pressure. The study purpose is to determine if changes in optic-nerve-head (ONH) shape reflect a treatment effect (acetazolamide/placebo + weight management) using the optical coherence tomography (OCT) substudy of the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT) at baseline, 3, and 6 months. The pRPE/BM shape deformation was quantified and compared with ONH volume, peripapillary retinal nerve fiber layer (pRNFL), and total retinal (pTR) thicknesses in the acetazolamide group (39 subjects) and placebo group (31 subjects) at baseline, 3, and 6 months. Mean changes of the pRPE/BM shape measure were significant and in the positive direction (away from the vitreous) for the acetazolamide group (P < 0.01), but not for the placebo group. The three OCT measures reflecting the reduction of optic disc swelling were significant in both treatment groups but greater in the acetazolamide group (P < 0.01). Change in the pRPE/BM shape away from the vitreous reflects the effect of acetazolamide + weight management in reducing the pressure differential between the intraocular and retrobulbar arachnoid space. Weight management alone was also associated with a decrease in optic nerve volume/edema but without a significant change in the pRPE/BM shape, implying an alternative mechanism for improvement in papilledema and axoplasmic flow, independent of a reduction in the pressure differential. (ClinicalTrials.gov number, NCT01003639.).

Pseudotumor Cerebri - drug therapy

Follow-Up Studies

Humans

Middle Aged

Carbonic Anhydrase Inhibitors - administration & dosage

Male

Treatment Outcome

Tomography, Optical Coherence - methods

Acetazolamide - administration & dosage

Pseudotumor Cerebri - physiopathology

Retinal Pigment Epithelium - pathology

Cerebrospinal Fluid Pressure - drug effects

Time Factors

Adult

Female

Pseudotumor Cerebri - pathology

Acetazolamide - therapeutic use

Optic Disk - pathology

Retinal Pigment Epithelium - drug effects

Details

Title: Subtitle: Peripapillary Retinal Pigment Epithelium Layer Shape Changes From Acetazolamide Treatment in the Idiopathic Intracranial Hypertension Treatment Trial
Creators: Jui-Kai Wang - Department of Electrical and Computer Engineering, The University of Iowa, Iowa City, Iowa, United States
Randy H Kardon - Iowa City VA Health Care System and Iowa City VA Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa, United States 3Department of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, Iowa, United States
Johannes Ledolter - Iowa City VA Health Care System and Iowa City VA Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa, United States 4Department of Management Sciences/Department of Statistics and Actuarial Science, The University of Iowa, Iowa City, Iowa, United States
Patrick A Sibony - Department of Ophthalmology, University Hospital and Medical Center, SUNY Stony Brook, Stony Brook, New York, United States
Mark J Kupersmith - Icahn School of Medicine at Mount Sinai and New York Eye and Ear Infirmary, New York, New York, United States
Mona K Garvin - Department of Electrical and Computer Engineering, The University of Iowa, Iowa City, Iowa, United States 2Iowa City VA Health Care System and Iowa City VA Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa, United States
OCT Sub-Study Committee and the NORDIC Idiopathic Intracranial Hypertension Study Group
Resource Type: Journal article
Publication Details: Investigative ophthalmology & visual science, Vol.58(5), pp.2554-2565
DOI: 10.1167/iovs.16-21089
PMID: 28492874
PMCID: PMC5425231
NLM abbreviation: Invest Ophthalmol Vis Sci
ISSN: 0146-0404
eISSN: 1552-5783
Publisher: United States
Grant note: U10 EY017387 / NEI NIH HHS R01 EY023279 / NEI NIH HHS U10 EY017281 / NEI NIH HHS
Language: English
Date published: 05/01/2017
Academic Unit: Statistics and Actuarial Science; Electrical and Computer Engineering; Iowa Neuroscience Institute; Business Analytics; Ophthalmology and Visual Sciences
Record Identifier: 9983979958602771

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