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Acetazolamide improves vision in patients with idiopathic intracranial hypertension

Acetazolamide in combination with a weight-reduction diet slightly improved vision in patients with idiopathic intracranial hypertension, according to a study.

The Idiopathic Intracranial Hypertension Treatment Trial, a multicenter, randomized, double-masked study, included 161 women and four men with idiopathic intracranial hypertension and mild vision loss.

Eighty-six patients received acetazolamide, and 79 patients received a placebo. Dosage was up to 4 g daily. All patients were on a low-sodium weight-reduction diet.

The primary outcome measure was the change in perimetric mean deviation at 6 months. Secondary measures were changes in papilledema grade, Visual Function Questionnaire (VFQ-25) scores, Short Form Health Survey (SF-36) scores, headache disability and weight at 6 months.

Mean perimetric mean deviation improved from –3.53 dB at baseline to –2.10 dB at 6 months in the acetazolamide group and from –3.53 dB to –2.82 dB in the placebo group; the between-group difference was statistically significant (P = .05).
Papilledema grade decreased from 2.76 to 1.45 in the acetazolamide group and from 2.76 to 2.15 in the placebo group. The difference between the groups was statistically significant (P < .001).

VFQ-25 scores improved from 82.97 to 91.30 in the acetazolamide group and from 82.97 to 84.95 in the placebo group (P = .003). SF-36 scores improved significantly more in the acetazolamide group than in the placebo group (P = .03).

Patients in the acetazolamide group lost significantly more weight than those in the placebo group (P < .001).

Both groups had similar visual acuity and headache disability.

Disclosure: See the study for a full list of all authors’ relevant financial disclosures.

Acetazolamide in combination with a weight-reduction diet slightly improved vision in patients with idiopathic intracranial hypertension, according to a study.

The Idiopathic Intracranial Hypertension Treatment Trial, a multicenter, randomized, double-masked study, included 161 women and four men with idiopathic intracranial hypertension and mild vision loss.

Eighty-six patients received acetazolamide, and 79 patients received a placebo. Dosage was up to 4 g daily. All patients were on a low-sodium weight-reduction diet.

The primary outcome measure was the change in perimetric mean deviation at 6 months. Secondary measures were changes in papilledema grade, Visual Function Questionnaire (VFQ-25) scores, Short Form Health Survey (SF-36) scores, headache disability and weight at 6 months.

Mean perimetric mean deviation improved from –3.53 dB at baseline to –2.10 dB at 6 months in the acetazolamide group and from –3.53 dB to –2.82 dB in the placebo group; the between-group difference was statistically significant (P = .05).
Papilledema grade decreased from 2.76 to 1.45 in the acetazolamide group and from 2.76 to 2.15 in the placebo group. The difference between the groups was statistically significant (P < .001).

VFQ-25 scores improved from 82.97 to 91.30 in the acetazolamide group and from 82.97 to 84.95 in the placebo group (P = .003). SF-36 scores improved significantly more in the acetazolamide group than in the placebo group (P = .03).

Patients in the acetazolamide group lost significantly more weight than those in the placebo group (P < .001).

Both groups had similar visual acuity and headache disability.

Disclosure: See the study for a full list of all authors’ relevant financial disclosures.

    Perspective

    Idiopathic intracranial hypertension (IIH) can be a disabling disease that is challenging to manage. This study provides strong evidence for the benefit of the addition of acetazolamide to weight loss and a low-sodium diet. In this study there were a large number of patients who withdrew from therapy. This may be due to side effects of the medication, difficulty with visit schedules or undertreatment. A significant number of patients may still require neurosurgical consultation for possible cerebrospinal fluid diversion or shunt placement and possible optic nerve sheath fenestration. This study is an important addition to the body of evidence that supports acetazolamide and weight loss as critical elements of the medical management of IIH.

    • Douglas J. Rhee, MD; and Atif B.D. Collins, MD
    • Rhee is an OSN Glaucoma Board member and Collins can be reached at the Departments of Ophthalmology and Plastic Surgery, Case Western Reserve University Center for Oculoplastics and Neuro-Ophthalmology, University Hospitals Eye Institute, Cleveland

    Disclosures: Rhee and Collins have no relevant financial disclosures.