title: The Effect of Treatment of Idiopathic Intracranial Hypertension on Prevalence of Retinal and Choroidal Folds.
abstract: OBJECTIVE
  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.
authors.affiliation: 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.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Kupersmith
authors.affiliation: Department of Ophthalmology, State University of New York at Stony Brook, Stony Brook, New York.
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Sibony
authors.affiliation: Department of Ophthalmology, University of Rochester School of Medicine & Dentistry, Rochester, New York.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Feldon
authors.affiliation: Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa.
authors.forename: Jui-Kai
authors.initials: JK
authors.lastname: Wang
authors.affiliation: Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa.
authors.forename: Mona
authors.initials: M
authors.lastname: Garvin
authors.affiliation: Department of Ophthalmology and Vision Sciences, Iowa City VA Health Care System, Iowa City, Iowa.
authors.forename: Randy
authors.initials: R
authors.lastname: Kardon
mesh_terms: D000086:Acetazolamide / Q000008:administration & dosage*; D002257:Carbonic Anhydrase Inhibitors / Q000008:administration & dosage; D002829:Choroid / Q000473:pathology*; D004305:Dose-Response Relationship, Drug; D005500:Follow-Up Studies; D006801:Humans; D009412:Nerve Fibers / Q000473:pathology; D010211:Papilledema / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence; D011559:Pseudotumor Cerebri / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D012160:Retina / Q000473:pathology*; D012165:Retinal Ganglion Cells / Q000473:pathology*; D012189:Retrospective Studies; D013997:Time Factors; D041623:Tomography, Optical Coherence / Q000379:methods*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014792:Visual Acuity
chemical_list: D002257:Carbonic Anhydrase Inhibitors; D000086:Acetazolamide