Abstract
BackgroundCarbonic anhydrase inhibitors (CAI) are often used in the treatment of cystoid macular edema (CME) in retinitis pigmentosa (RP) patients. The aim of this meta-analysis is to gain a better understanding of the overall efficacy of CAI treatment.MethodsDatabases including PubMed, EMBASE, and Cochrane Library were searched to identify relevant studies. Eligible studies were clinical trials of patients with RP assigned topical or oral CAIs such as dorzolamide and acetazolamide. Changes in central macular thickness (CMT) by OCT in μm and best-corrected visual acuity (BCVA) in log MAR equivalents were extracted and results compared between baseline and after treatment.Results11 clinical reports were identified which included a total of 194 patients (358 eyes) available for analysis, with 59 patients (115 eyes) assigned oral CAI treatment and 135 patients (243 eyes) assigned topical CAI treatment. The combined results showed a significant reduction of macular edema, as calculated by baseline and final central macular thickness (CMT) based on OCT examination (46.02μm, 95%CI: -60.96, -31.08, I2 = 65%). However, the effect on visual acuity was inconsistent across studies.ConclusionBased on non randomized controlled clinical studies, RP patients with CME who were treated with CAIs had better anatomical outcomes, but the effect on visual acuity was contradictory across studies. Multicenter prospective randomized controlled trials would be ideal to definitively test its clinical efficacy in RP patients.
Highlights
Retinitis pigmentosa (RP) is a heterogeneous group of inherited retinal disorders
11 clinical reports were identified which included a total of 194 patients (358 eyes) available for analysis, with 59 patients (115 eyes) assigned oral Carbonic anhydrase inhibitors (CAI) treatment and 135 patients (243 eyes) assigned topical CAI treatment
The combined results showed a significant reduction of macular edema, as calculated by baseline and final central macular thickness (CMT) based on optical coherence tomography (OCT) examination (46.02μm, 95%confidence interval (CI): -60.96, -31.08, I2 = 65%)
Summary
Retinitis pigmentosa (RP) is a heterogeneous group of inherited retinal disorders. According to the inheritance pattern, it is usually classified into three subtypes: autosomal dominant, autosomal recessive, and X-linked forms. Clinical symptoms of RP patients include night blindness and progressive visual field loss resulting from degeneration of photoreceptors, which eventually leads to blindness. Complications such as an epi-retinal membrane, cataracts, or cystoid macular edema (CME) can can cause early visual loss. Carbonic anhydrase inhibitors (CAI) are often used in the treatment of cystoid macular edema (CME) in retinitis pigmentosa (RP) patients. The aim of this meta-analysis is to gain a better understanding of the overall efficacy of CAI treatment.
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