What is the optimal dose of acetazolamide in the treatment of idiopathic intracranial hypertension

@#Objective: Acetazolamide is preferred as the first-line drug for the medical treatment of idiopathic intracranial hypertension. In this study, the efficacy of different doses of the drug on visual functions; visual acuity, optic disc appearance- papilledema grade and visual field-mean deviation (VF-MD) were evaluated. Methods: The medical records of 73 patients diagnosed as idiopathic intracranial hypertension based on Modified Dandy Criteria and treated with acetazolamide who were on follow-up between 2010 and 2017 at the Neuro-ophthalmology Unit of Ege University Medical School, Department of Neurology were analyzed. Improvement in the visual functions at the end of the sixth month in three groups taking different doses of the drug; low (500, 750, 1000 mg/day), moderate (1500, 1750, 2000 mg/day) and high (3000, 4000 mg/day) were compared. Results: Improvement in visual acuity (p: 0.784), was not affected from different doses of the drug whereas papilledema grade (p: 0.014) and VF-MD (p<0.001) were affected. Binary comparisons revealed significant improvement in the high dose group when compared with the moderate and low dose groups both for the papilledema grade (lowhigh: p: 0.003, moderate-high: p: 0.024 ) and VF-MD (low-high: p<0.001, moderate-high: p: 0.001) Conclusion: Treatment with high doses of acetazolamide is associated with improvement in visual field defects and regression of optic disc edema in idiopathic intracranial hypertension.

Analysis of Peripapillary Atrophy According to the Optic Disc Shape Using Spectral Domain OCT

PURPOSE: To analyze the structural changes in the beta-zone of peripapillary atrophy (PPA-beta) using cross-sectional image of the optic disc head from spectral-domain optical coherence tomography (SD-OCT) according to the optic disc shape. METHODS: One hundred thirty-seven eyes in 137 patients with glaucoma having PPA-beta and 31 normal eyes (control group) were evaluated retrospectively. Cross-sectional images of the optic disc were taken using the Cirrus HD-OCT. We classified optic disc patterns into normal, focal, myopic, generalized enlargement and senile sclerotic appearance types and analyzed the shape of Bruch's membrane (BM), composition of retinal layer and retinal slope according to the optic disc shape. RESULTS: Among the 137 eyes with glaucoma, 54 eyes were focal disc type, 34 eyes were myopic disc type, 28 eyes were generalized enlargement disc type and 21 eyes were senile sclerotic disc type. The myopic disc group showed a noticeable difference compared to the other groups in terms of a higher percentage of BM defect type, the lowest retinal slope (70.6 +/- 12.0degrees) and the earlier termination of retinal layers. The generalized enlargement disc group showed the highest percentage of curved BM type. Retinal slope angle increased with age and decreased with axial length. CONCLUSIONS: In the beta-zone of peripapillary atrophy, there were several differences in the shape of Bruch's membrane, composition of retinal layers and the retinal slope according to the optic disc shape.