The Effect of Treatment of Idiopathic Intracranial Hypertension on Prevalence of Retinal and Choroidal Folds.
Kupersmith Mark J, Sibony Patrick A, Feldon Steven E, Wang Jui-Kai, Garvin Mona, Kardon Randy
AI Summary
Acetazolamide treatment for IIH significantly reduced retinal and choroidal folds, but not creases, reflecting biodynamic changes. Persistent folds despite swelling reduction suggest permanent tissue alterations.
Abstract
Purpose
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.
Methods
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.
Results
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.
Conclusions
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.
MeSH Terms
Shields Classification
Key Concepts5
At 6 months, acetazolamide-treated eyes (n = 44) had fewer folds of all types (P < .01) compared to placebo-treated eyes (n = 43), with a 57% reduction in the frequency of retinal folds in a randomized clinical trial for idiopathic intracranial hypertension.
In a randomized clinical trial, the resolution of retinal folds in patients with idiopathic intracranial hypertension treated with acetazolamide was associated with a significant reduction in retinal nerve fiber layer thickness, optic nerve head volume, and papilledema grade.
In a randomized clinical trial, creases in the outer retina associated with papilledema due to idiopathic intracranial hypertension did not resolve after 6 months of treatment with acetazolamide.
The persistence of various types of retinal folds, despite marked improvement in optic nerve head swelling with acetazolamide treatment, suggests permanent changes in the affected retinal tissues in patients with idiopathic intracranial hypertension.
At presentation, eyes treated with acetazolamide (ACZ, n = 44) showed an increase of peripapillary wrinkles (PPW) in 64% of cases compared to 28% in the placebo group (n = 43) in a randomized clinical trial.
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