title: Efficacy and prognostic factors of response to carbonic anhydrase inhibitors in management of cystoid macular edema in retinitis pigmentosa.
abstract: OBJECTIVE
  To determine the efficacy and prognostic factors associated with carbonic anhydrase inhibitors (CAI) in the treatment of cystoid macular edema (CME) in retinitis pigmentosa (RP).
  
  
  METHODS
  This was a cohort study of 81 subjects who were assessed before and after treatment. Spectral-domain optical coherence tomography (SD-OCT) was used to quantify CME. A reduction of at least 11% in central subfield (CSF) thickness was defined as objective evidence of response.
  
  
  RESULTS
  In the 125 eyes that received topical dorzolamide, 40.0% demonstrated a response to treatment with a mean reduction in OCT CSF thickness of 105 μm (95% confidence interval [CI]: 82, 128). Mean starting visual acuity (VA) increased from 6/15 to 6/12 after a median time on treatment of 3.0 months. In patients prescribed oral acetazolamide, 28.1% of eyes (41.2% of patients) showed improvement in mean OCT CSF thickness of 115 μm (95% CI: 52, 177) over a median treatment interval of 4.0 months. Visual acuity improved from 6/15 to 6/12. Eyes that responded to topical dorzolamide were more likely to have autosomal recessive than autosomal dominant RP (44.6% vs. 23.3%, P = 0.02), and a higher mean baseline OCT CSF than eyes that did not respond (P = 0.02).
  
  
  CONCLUSIONS
  We report that 40.0% of eyes (53.1% of patients) showed an objective improvement in CME after treatment with topical dorzolamide and 28.1% of eyes (41.2% of patients) after treatment with oral acetazolamide. Autosomal recessive RP and greater initial central retinal thickness predicted response to treatment with topical dorzolamide.
authors: Centre for Vision Research, Westmead Millennium Institute, University of Sydney, Sydney, Australia Moorfields Eye Hospital, London, United Kingdom.
authors: Gerald
authors: G
authors: Liew
authors: Moorfields Eye Hospital, London, United Kingdom University College London, Institute of Ophthalmology, London, United Kingdom.
authors: Anthony T
authors: AT
authors: Moore
authors: Moorfields Eye Hospital, London, United Kingdom University College London, Institute of Ophthalmology, London, United Kingdom.
authors: Andrew R
authors: AR
authors: Webster
authors: Moorfields Eye Hospital, London, United Kingdom University College London, Institute of Ophthalmology, London, United Kingdom.
authors: Michel
authors: M
authors: Michaelides
mesh_terms: D000086:Acetazolamide / Q000627:therapeutic use*; D000284:Administration, Oral; D000328:Adult; D002257:Carbonic Anhydrase Inhibitors / Q000627:therapeutic use*; D015331:Cohort Studies; D003692:Delayed-Action Preparations; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008269:Macular Edema / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions; D012174:Retinitis Pigmentosa / Q000175:diagnosis / Q000188:drug therapy*; D012189:Retrospective Studies; D013449:Sulfonamides / Q000627:therapeutic use*; D013876:Thiophenes / Q000627:therapeutic use*; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome
chemical_list: D002257:Carbonic Anhydrase Inhibitors; D003692:Delayed-Action Preparations; D009883:Ophthalmic Solutions; D013449:Sulfonamides; D013876:Thiophenes; C062765:dorzolamide; D000086:Acetazolamide
keywords: acetazolamide; cystoid macular edema; dorzolamide; retinitis pigmentosa