The Effect of Treatment of Idiopathic Intracranial Hypertension on Prevalence of Retinal and Choroidal Folds

Mark J Kupersmith; Patrick A Sibony; Steven E Feldon; Jui-Kai Wang; Mona Garvin; Randy Kardon; OCT Sub-Study Group for the NORDIC Idiopathic Intracranial Hypertension Treatment Trial

doi:10.1016/j.ajo.2016.12.017

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The Effect of Treatment of Idiopathic Intracranial Hypertension on Prevalence of Retinal and Choroidal Folds

Journal article

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Peer reviewed

The Effect of Treatment of Idiopathic Intracranial Hypertension on Prevalence of Retinal and Choroidal Folds

Mark J Kupersmith, Patrick A Sibony, Steven E Feldon, Jui-Kai Wang, Mona Garvin, Randy Kardon and OCT Sub-Study Group for the NORDIC Idiopathic Intracranial Hypertension Treatment Trial

American journal of ophthalmology, Vol.176, pp.77-86

04/2017

DOI: 10.1016/j.ajo.2016.12.017

PMCID: PMC5376523

PMID: 28040526

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Abstract

We described 3 types of folds in the retina and a crease in the outer retina associated with papilledema owing to idiopathic intracranial hypertension (IIH) at presentation. We report the change in folds relative to treatment of IIH over the 6 months. In this substudy of a randomized clinical trial, study eyes of subjects assigned to acetazolamide (ACZ, n = 44) or placebo (PLB, n = 43) had spectral-domain optical coherence tomography (SDOCT) images of the optic disc and macula regions at baseline and at 3 and 6 months. Images were evaluated for peripapillary wrinkles (PPW), retinal folds (RF), choroidal folds (CF), and creases using transaxial and en face views. The optic nerve head (ONH) shape, retinal nerve fiber layer (RNFL) thickness, ONH volume, and papilledema grade were measured. Outcome was determination of the presence or absence of PPW, RF, CF, and creases. At presentation, except for an increase of PPW in ACZ eyes (64% vs 28%), both treatment groups were matched for all OCT features. At 6 months, ACZ-treated, but not PLB-treated, eyes had fewer folds of all types (P < .01), with a 57% reduction in frequency of RF. Creases did not resolve. Resolution of RF, but not of PPW and CF, was associated with significant reduction in RNFL thickness, ONH volume, and papilledema grade. The various types of retinal folds associated with papilledema reflect biodynamic processes and show an ACZ treatment effect. Persistence of these folds despite marked improvement in ONH swelling suggests permanent changes in the affected retinal tissues.

Nerve Fibers - pathology

Pseudotumor Cerebri - drug therapy

United States - epidemiology

Prevalence

Follow-Up Studies

Humans

Carbonic Anhydrase Inhibitors - administration & dosage

Treatment Outcome

Tomography, Optical Coherence - methods

Visual Acuity

Papilledema - epidemiology

Acetazolamide - administration & dosage

Pseudotumor Cerebri - physiopathology

Retinal Ganglion Cells - pathology

Dose-Response Relationship, Drug

Time Factors

Pseudotumor Cerebri - complications

Papilledema - diagnosis

Retrospective Studies

Choroid - pathology

Retina - pathology

Papilledema - etiology

Details

Title: Subtitle: The Effect of Treatment of Idiopathic Intracranial Hypertension on Prevalence of Retinal and Choroidal Folds
Creators: Mark J Kupersmith - Mount Sinai West Hospital, New York, New York; New York Eye and Ear Infirmary and Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: mkuper@chpnet.org
Patrick A Sibony - Department of Ophthalmology, State University of New York at Stony Brook, Stony Brook, New York
Steven E Feldon - Department of Ophthalmology, University of Rochester School of Medicine & Dentistry, Rochester, New York
Jui-Kai Wang - Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa
Mona Garvin - Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa
Randy Kardon - Department of Ophthalmology and Vision Sciences, Iowa City VA Health Care System, Iowa City, Iowa
OCT Sub-Study Group for the NORDIC Idiopathic Intracranial Hypertension Treatment Trial
Resource Type: Journal article
Publication Details: American journal of ophthalmology, Vol.176, pp.77-86
DOI: 10.1016/j.ajo.2016.12.017
PMID: 28040526
PMCID: PMC5376523
NLM abbreviation: Am J Ophthalmol
ISSN: 0002-9394
eISSN: 1879-1891
Publisher: United States
Grant note: U10 EY017387 / NEI NIH HHS R01 EY023279 / NEI NIH HHS U10 EY017281 / NEI NIH HHS
Language: English
Date published: 04/2017
Academic Unit: Electrical and Computer Engineering; Iowa Neuroscience Institute; Ophthalmology and Visual Sciences
Record Identifier: 9983980068202771

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