Oral Acetazolamide Research Articles

Urgent Management of Secondary Glaucoma in Uveitis Using the Xen-45 Gel Stent.

The Xen-45 implant is an effective and safe treatment option for patients with medically uncontrolled glaucoma in the setting of uveitis, including those where urgent surgical intervention is required. The purpose of this study was to report the efficacy and safety of the Xen-45 gel stent in eyes with glaucoma secondary to uveitis. Retrospective observational case series of 37 eyes, with medically uncontrolled glaucoma in uveitis using Xen-45 implantation. All patients had at least 12 months follow-up. Primary outcome measures included visual acuity, intraocular pressure (IOP), degree of inflammation and ocular hypotensive medications. In addition, the time taken from the decision to surgery was recorded. Data were collected preoperatively and 1 day, 1 week, 1, 3, 6, and 12 months postoperatively. Postoperative complications included hypotony and decompressive retinopathy. The requirement for further glaucoma surgery, including bleb needling, and failure were documented. The mean follow-up time was 16.7 months (range: 12 to 32 mo). Preoperatively all patients were on >3 ocular hypotensive medications and 75.7% were on oral acetazolamide. Systemic immunosuppression was used in 62.2% and all were on topical steroids. Mean preoperative IOP was 36.1 mm Hg (±SD 9.6) on an average 3.69 (±SD 0.47) drops. The median time from decision to operate to surgery was 5.5 days (range: 1 to 120 d). Mean postoperative IOP was 12.6 mm Hg (±SD 4.1) with an average 0.62 (±SD 1.1) drops at 1 year representing a 65% drop in IOP and 83% reduction in IOP-lowering medication. Bleb needling with 5-fluorouracil was performed on 5 eyes (13.5%). Symptomatic hypotony occurred in 7 eyes requiring further interventions. No decompressive retinopathy was found at last follow-up. Five eyes (13.5%) failed, needing drainage tube surgery or trabeculectomy. The Xen-45 implant is an effective treatment for hypertensive crises in glaucoma in uveitis, offering dramatic IOP lowering without significant uveitis flare-up. In this group of patients with uveitis, needling rates are lower than reported in primary open-angle glaucoma. However, complications including hypotony can still occur.

A 50-year-old woman presented with severe reduction of vision and recurrent pain in right eye following cataract surgery

This article has no abstract. The first 100 words appear below: A 50-year-old female, hailing from Patuakhali, was admitted at the Department of Ophthalmology for the management of severe reduction of vision and pain at the right eye for the last 7 months following cataract surgery at a government hospital. Her cataract surgery (small incision cataract surgery with PC-IOL implantation) of the right eye was performed on October 28, 2018. On the first post-operative day, she developed pain, redness and severe reduction of vision in the right eye. The following day, she was discharged with the advice of some medications like moxifloxacin, dexamethasone, bromfenac eye drops and oral acetazolamide and potassium.

Combined Topical Anti-inflammatory and Oral Acetazolamide in the Treatment of Central Serious Chorioretinopathy. Optom Vis Sci 2019;96: 500-6.

Combined Topical Anti-inflammatory and Oral Acetazolamide in the Treatment of Central Serious Chorioretinopathy. Optom Vis Sci 2019;96: 500-6.

Successful use of oral acetazolamide in symptomatic subcutaneous calcifications in hyperphosphatemic tumoral calcinosis

Successful use of oral acetazolamide in symptomatic subcutaneous calcifications in hyperphosphatemic tumoral calcinosis

Combined Topical Anti-inflammatory and Oral Acetazolamide in the Treatment of Central Serous Chorioretinopathy.

Central serous chorioretinopathy (CSCR) is still a therapeutic challenge with no criterion standard treatment. However, anatomic changes at the level of the retinal pigment epithelium could prove of predictive value in the course of the disease for selective treatment in cases of increased risk of chronicity. This pilot study analyzes the efficacy for treating acute CSCR with combined systemic acetazolamide 250 mg twice a day and nepafenac 0.1% eye drops three times a day in comparison with an untreated control group. It also evaluates the presence a pigment epithelial detachment (PED) as a risk factor for chronic CSCR. Nineteen consecutive patients (group 1) with new or new onset of recurrent CSCR were treated with oral acetazolamide and nepafenac eye drops for at least 2 months. A control group of 14 patients (group 2) with new or new onset of recurrent CSCR were untreated while under regular observation for 4 months. Primary end points were central macular thickness and best-corrected visual acuity after 4 months. Secondary end points were complete regression of subretinal fluid at 3 months and association of PED at baseline with recurrent or chronic CSCR imaged by optical coherence tomography. Group 1 showed significantly faster resolution of subretinal fluid with a mean central macular thickness at 4 months of 271 ± 85 μm compared with 322 ± 79 μm for group 2 (P < .05), but with no functional benefit with a best-corrected visual acuity at 4 months of 0.8 ± 0.2 for group 1 compared with 0.9 ± 0.1 for the control group (P < .05). Patients with a small flat PED were at a higher risk of developing chronic CSCR compared with patients with a dome-shaped or no PED (P < .05). Central serous chorioretinopathy remains a therapeutic challenge. This pilot study shows faster resolution of subretinal fluid with treatment but without functional benefit compared with observation. The presence of small, flat PED was associated with development of chronic CSCR.

RESPONSE OF INFLAMMATORY CYSTOID MACULAR EDEMA TO TREATMENT USING ORAL ACETAZOLAMIDE.

To determine the treatment effect of oral acetazolamide on refractory inflammatory macular edema. A retrospective review of identified patients with uveitic or pseudophakic macular edema treated using acetazolamide between 2007 and 2014. Visual acuity and central macular subfield thickness was determined at baseline and at first follow-up. Baseline optical coherence tomography features were analyzed as predictors of acetazolamide response. Sixteen patients (19 eyes) of 61 screened met all criteria. Mean age was 57.9 years (19.7-81.1). The most common diagnosis was idiopathic uveitis (n = 6, 31.6%). Mean uveitis duration was 4.4 years (0.2-27.5). Average central macular subfield thickness decreased significantly (from 471.8 ± 110.6 μm to 358.3 ± 50.4 μm) (P < 0.0001). Average visual acuity (logarithm of the minimum angle of resolution) improved significantly from 20/54 (0.43 ± 0.25) to 20/37 (0.27 ± 0.16) (P = 0.003). Pretreatment optical coherence tomographies demonstrated intraretinal fluid (n = 19, 100%), subretinal fluid (n = 8, 42.1%), epiretinal membrane (n = 13, 68.3%), and vitreomacular traction (n = 1, 5.2%). No optical coherence tomography characteristic was predictive of a response to therapy. There is a significant benefit to vision and central macular subfield thickness after acetazolamide treatment in patients with inflammatory macular edema. In patients with refractory inflammatory macular edema, treatment using acetazolamide can provide anatomical and visual benefit without corticosteroid-related adverse effects.

Efficacy and safety of transscleral cyclophotocoagulation in Swedish glaucoma patients.

To retrospectively evaluate the efficacy and safety of all transscleral cyclophotocoagulation (TCP) treatments performed during a 5-year period. Medical records of all patients, who had undergone TCP treatment between 2010 and 2014 at Umeå University Hospital, Sweden, were evaluated. Clinical data including intraocular pressure (IOP), visual acuity (VA), number of topical glaucoma medications, use of oral acetazolamide, retreatments and complications during a 2-year follow-up were registered. Global success was defined as IOP 6-18mmHg with or without glaucoma medication. Three hundred patients underwent TCP during the time period. Mean IOP at baseline was 29.3±11.0 (mean±standard deviation) mmHg (n=297) with a mean reduction of 11.5 (±12.0) mmHg at 1year (n=258; p<0.001) and 12.6 (±12.0) mmHg at 2-year follow-up (n=245; p<0.001). Global success at 2years was 64%, achieved by a mean of 1.2 treatments (n=257). The number of topical glaucoma medications at baseline was 3.1 (±1.0; n=296) and was reduced by 0.9 (±1.0) medications at 2years (n=244; p<0.001). Use of oral acetazolamide decreased from 30% (n=90) at baseline to 5.3% (n=13) at 2years. In eyes with Snellen VA≥0.1, the mean VA at baseline was 0.55 (±0.3) logarithm of the minimum angle of resolution (logMAR; n=132) and 1.1 (±0.9) logMAR (n=76) at 2years (p<0.001). No cases of phthisis bulbi were found. This study displays a substantial and long-term reduction of IOP following TCP with a decrease in topical and oral glaucoma medications. The treatment appears to be safe but the decrease in VA during follow-up is a concern that needs further evaluation.

Outcomes of Micropulse Transscleral Cyclophotocoagulation in Uncontrolled Glaucoma Patients.

This study aimed at evaluating the intermediate-term efficacy and safety of micropulse transscleral cyclophotocoagulation (MP-TSCPC) in cases of uncontrolled glaucoma. Patients with moderate to advanced glaucoma and uncontrolled intraocular pressure (IOP) despite maximally tolerable antiglaucoma medications were selected to undergo MP-TSCPC using the MP3 handpiece with the Iridex Cyclo G6 (IRIDEX Laser Systems). Follow-up examinations took place on a regular basis until 15 months postoperatively. Seventy-five eyes of 69 patients (53.6% male patients) were included. Mean age was 55.5±22.9 years. Primary open-angle glaucoma was the most common diagnosis. Corrected distance visual acuity at baseline ranged between 0 and 2.1 logMAR. Mean prelaser IOP was 26.0±7.91 mm Hg. This was reduced significantly to 13.8±5.6 mm Hg (44.0% reduction, P<0.001) at week 1, and to 18.0±7.7, 18.4±7.1, 16.7±6.2, 15.1±4.1, 15.7±5.32, and 14.8±5.50 mm Hg at months 1, 3, 6, 9, 12, and 15, respectively. The mean number of antiglaucoma drops decreased significantly up to 12 months of follow-up (P=0.008) and that of oral acetazolamide tablets decreased significantly up to 15 months (P<0.001). The success rate decreased progressively with time, reaching 81.4% at 6 months and 73.3% at 1 year. No major postoperative complications were encountered, and no eye lost vision completely. MP-TSCPC is an efficient noninvasive glaucoma treatment that achieves sustained IOP reduction and reduced need for ocular antihypertensive medications for up to 15 months. The optimal laser parameters to achieve the best success rate with the least side effects still need to be determined.

Management of Idiopathic Macular Telangiectasia Type 2.

Macular telangiectasia type 2 (MacTel) is a relatively rare disease without established treatments. Although MacTel was previously considered a primarily vascular condition, the thinking on its pathogenesis has shifted to it now being considered principally a neurodegenerative disease. This has resulted in a subsequent change in the approach to treatment toward neuro-protection for the non-proliferative phase of this disease. Carotenoid supplementation has had mixed results. Ciliary neurotrophic factor (CNTF) has demonstrated some promising early results, but further study is necessary to determine its actual effect. Some structural improvements have been seen in the non-proliferative phase with oral acetazolamide but without accompanying functional improvement. Anti-vascular endothelial drugs have been studied and not found to have benefit in the non-proliferative phase of disease but have demonstrated significant structural and functional value in the treatment of secondary neovascularization. There is no level I evidence for the various proposed MacTel treatments, and efforts need to be directed toward conducting multicenter randomized trials to better understand possible treatments for this condition.Electronic supplementary materialThe online version of this article (10.1007/s40123-019-0170-1) contains supplementary material, which is available to authorized users.

Oclusión de la arteria central de la retina iatrogénica tras angiografía de sustracción digital cerebral

Digital subtraction angiography (DSA) is a technique used in interventional radiology for the diagnosis of vascular cerebral conditions. Central retinal artery occlusion (CRAO) is a complication of endovascular procedures that involve atherosclerotic plaque removal with subsequent embolisation. The case is presented on a patient who noticed a sudden vision loss during a DSA. Funduscopy showed retinal pallor and a cherry red spot. The angiography showed a structure suggesting the presence of an embolus in the central retinal artery. The patient was diagnosed with a CRAO, and unsuccessfully treated with ocular massage, topical hypotensive drugs, oral acetazolamide, and anterior chamber paracentesis, with a final visual acuity of 0.05. Central retinal artery occlusion is a rare complication, but due to its poor prognosis, it must be considered when performing neuroradiological procedures such as DSA.

Oral Acetazolamide Administration to Control Intraocular Pressure on First Day Post Phacoemulsification Surgery : Is It Necessary ?

&#x0D; &#x0D; &#x0D; Introduction : The incidence of early postoperative intraocular pressure (IOP) increase is reported to be 2.3–8.9% in phacoemulsification surgery. This increase typically peaks at 3–7 hours after surgery and persists during the first 24 hours. Although most eyes can tolerate the transient IOP elevation that occurs after cataract surgery, IOP spikes are potentially more dangerous if it persist. In order to minimize postoperative intraocular pressure (IOP) rise, routine medication by oral acetazolamide has been widely used among ophthalmologists. Objective of this study is to investigate the relationship between IOP changes on first day after phacoemulsification with administration of oral acetazolamide. &#x0D; Method : This is a descriptive study. The samples were include 50 patients diagnosed with cataract who underwent phacoemulsification surgery with intraocular lens implantatios. Samples were randomized divided into two groups. First group is patient who treated with 250 mg acetazolamide post operative and other group is untreated. All respondents must have no history of glaucoma or ocular hypertensive and attend follow up on the first day postoperative. IOP is measured with non-contact tonometer. &#x0D; Results : Mean age of respondents is 61  9.8 years old. Preoperative IOP mean is 18.04  3.6 mmHg and postoperative IOP mean is 18.58  6.9 mmHg. This study revealed that there is no significant relation between oral administration of acetazolamide and the lowering of intraocular pressure on first day post phacoemulsification(p = 0.2) Visual acuity pre operative and nuclear density of cataract are also no relationship with the IOP on first day postoperative (p = 0.2 ) &#x0D; Conclusion : The use of oral acetazolamide is not significantly related to the IOP on first day post phacoemulsification surgery. &#x0D; &#x0D; &#x0D;

Safety and efficacy of a urine alkalinization protocol developed for high-dose methotrexate patients during intravenous bicarbonate shortage.

Urinary alkalinization with intravenous sodium bicarbonate is standard during high-dose methotrexate administration. Due to a national intravenous sodium bicarbonate shortage, a urinary alkalinization protocol involving hyperhydration with intravenous fluids, oral bicarbonate, and intravenous or oral acetazolamide was utilized from 10 April to 30 May 2017 ("shortage protocol"). This study compared outcomes between protocols. A single-center, retrospective chart review was conducted for adults who received methotrexate ≥500 mg/m2 on ≥ two occasions, at least once during each protocol, between 19 February and 19 July 2017. Eighteen patients (50% male), median age 65 years, received 76 total high-dose methotrexate cycles. Shortage protocol was used in 37 cycles (48.7%). Mean time to methotrexate clearance did not differ between groups (p = ns). Mean time to urinary alkalinization and duration of hospitalization were not statistically different (p = 0.49 and 0.23, respectively). Average total bicarbonate administered per 24 hours was higher in standard protocol (p < 0.05), but hydration rates were similar (p = 0.73). Creatinine clearance and urine output on days 1 and 2 post-high-dose methotrexate did not significantly differ (creatinine clearance day 1, p = 0.27; creatinine clearance day 2, p = 0.55; urine output day 1, p = 0.62; urine output day 2, p = 0.60). Interruptions in alkalinization were significantly higher during shortage (0.41 ± 0.75 instances of urine pH < 7 during standard vs. 1.3 ± 1.7 under shortage, p < 0.05).

Pseudotumour cerebri associated with mycoplasma pneumoniae infection and treatment with levofloxacin: a case report

BackgroundIdiopathic intracranial hypertension (IIH), also known as pseudotumour cerebri syndrome (PTCS), is characterized by the presence of signs and symptoms of raised intracranial pressure without evidence of any intracranial structural cause and with normal cerebrospinal fluid microscopy and biochemistry.Obesity, various systemic diseases and endocrine conditions, and a number of medications are known to be risk factors for PTCS. The medications commonly associated with PTCS are amiodarone, antibiotics, corticosteroids, cyclosporine, growth hormone, oral contraceptives, vitamin A analogues, lithium, phenytoin, NSAIDs, leuprolide acetate, and some neuroleptic drugs. In relation to antibiotics, quinolones may cause intracranial hypertension, and most reported cases of quinolone-induced intracranial hypertension were associated with nalidixic acid, ciprofloxacin, ofloxacin, or pefloxacin. Literature reports of levofloxacin-induced PTCS are rare. Some authors recently hypothesized that Mycoplasma pneumoniae may trigger PTCS.Case presentationWe report on a 14-year-old overweight White Italian boy who suffered headache, diplopia, and severe bilateral papilloedema after a Mycoplasma pneumoniae infection, exacerbated on levofloxacin intake. A spontaneous improvement in headache and a reduction in diplopia was seen during hospitalisation. Oral acetazolamide therapy led to the regression of papilloedema in about five months. No permanent eye damage has been observed in our patient to date.ConclusionsPTCS pathophysiology may be multifactorial and its specific features and severity may be a consequence of both constitutional and acquired factors interacting synergistically. It may be useful for paediatricians to know that some antibiotics may have the potential to precipitate PTCS in patients who already have an increased CSF pressure due to a transitory imbalanced CSF circulation caused by infections such as Mycoplasma pneumoniae, with headache being the first and most sensitive, but also the least specific, symptom.

Oral Regimen for Urine Alkalization in Patients Receiving High Dose Methotrexate during a National Shortage of Intravenous Sodium Bicarbonate

▪Background: High dose methotrexate (MTX) is an important agent in the prevention and treatment of cancer in the central nervous system. Administration of this drug requires alkalization of the urine, which traditionally includes the use of intravenous (IV) sodium bicarbonate (bicarb). In May 2017, IV bicarb was on national shortage; at the University of Virginia, pharmacists and physicians designed an oral (PO) regimen using bicarb and acetazolamide to ensure patients could continue receiving MTX. As there are limited published data, we aimed to assess the safety and the impact on time to start of MTX.Methods: Retrospective chart review was done 5/2016-4/2017 to establish a baseline time to methotrexate. In a prospective analysis, data was collected from May 2017 to May 2018 on all patients who received MTX. For patients receiving the PO regimen, bicarb 2,600 mg PO 6 times daily and acetazolamide 250 mg PO every 6 hours were the initial doses and titrated to maintain a urine pH greater than or equal to 7. The primary endpoint was time to MTX for patients with planned admissions who start MTX upon meeting urine pH and output parameters. Secondary endpoints included incidence of acute kidney injury (AKI) and delayed methotrexate clearance for all patient encounters. AKI was defined using Kidney Disease Improving Global Outcomes criteria. Delayed MTX clearance was defined based on failure to meet goal levels based on published chemotherapy protocols. χ2 analysis was completed on categorical variables. A statistical process control chart (p-chart) depicted time to MTX.Results: A total of 162 patient encounters were included in the analysis. The median age of patients receiving oral bicarb was 51 years (range 21-69) and was 51 years (range 21-63) for patients receiving IV bicarb. Eighty-six encounters were planned admissions that started MTX when urine parameters were met and received either IV (n=32) or PO bicarb (n=54). In these patients median time from admission to MTX was 8.4 vs 7.9 hours, respectively. Figure 1 shows consecutive patients receiving MTX prior to, during, and after resolution of the IV bicarb shortage; there is less variability and fewer outliers in the MTX start time when exclusively administering the PO regimen during the shortage. For the secondary analysis an additional 76 encounters with either unplanned admissions or predetermined MTX start time on subsequent day to admission were analyzed for safety outcomes. The rate of AKI was 14.5% vs 8.9% in the PO vs IV groups, respectively (p=0.28). There was no difference in incidence of delayed methotrexate clearance with 26.5% of patients in PO group vs 25.3% patients in IV group (p=0.87). Length of stay was slightly increased in patients who received PO vs IV alkalization (3.78 vs 3.15 days).Conclusion: Our alternative oral bicarb and acetazolamide urine alkalization regimen appears safe in patients receiving MTX and allowed for continued treatment of patients during a national IV bicarb shortage. Time to start of MTX was decreased with implementation of PO regimen, and there appeared to be a more predictable start time for MTX. While not significant, the higher incidence of AKI in PO group warrants further analysis. Future efforts include using oral outpatient alkalization prior to inpatient admission to work towards improving length of stay. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Use of acetazolamide in the treatment of patients with refractory congestive heart failure.

Optimal diuretic treatment of patients with refractory congestive heart failure (CHF) remains to be elucidated. In this work, we aimed to evaluate the serial changes of functional class and surrogates of fluid overload (weight and antigen carbohydrate 125) after addition of oral acetazolamide in patients with refractory CHF. Likewise, serial changes in renal function, serum electrolytes and pH were evaluated. This is an observational retrospective study in which 25 ambulatory patients with refractory CHF that received acetazolamide in addition to standard intensive diuretic strategy were evaluated. Longitudinal assessment of New York Heart Association (NYHA) functional class and biomarkers was analyzed using joint modelling of longitudinal and survival data. All patients showed NYHA class III/IV at baseline. After prescription of acetazolamide, a total of 125 outpatient visits were recorded [median visits per patient: 6 (IQR=3-7)] during a median follow-up of 152days (IQR=80-353). A significant decrease in NYHA class, weight, and antigen carbohydrate 125 was observed. On the other hand, estimated glomerular filtration rate increased over time. No significant changes in systolic blood pressure, serum sodium, potassium, amino-terminal pro-brain natriuretic peptide, and pH occurred. In a cohort of patients with refractory CHF treated with an intensive diuretic treatment, the addition of acetazolamide was associated with improvement in functional class and surrogates of fluid overload.

Ocular administration of acetazolamide microsponges in situ gel formulations

In the present work, the antiglaucoma drug, acetazolamide, was formulated as microsponges in situ gel for ocular drug delivery aiming an improved therapeutic efficacy and reduction in the systemic side effects of oral acetazolamide. The microsponges were prepared by the quasi emulsion solvent diffusion method and were incorporated into 25% pluronic F-127 in situ gel. Ethyl cellulose polymer in different proportions with drug was used to prepare the microsponges. Different parameters were evaluated to select the best formulation. The formula S2 with drug to polymer ratio (2:1) showed high entrapment efficiency of about 82% and mean particle size of about 10 µm with polydispersity index (PDI) of 0.22, which are suitable characters for ocular delivery. The in situ gels were evaluated for physicochemical properties (pH, gelling capacity, gelation time and rheological properties) and in vivo studies. S2 formulation showed higher therapeutic efficacy compared to free drug in gel. It was non irritant to the rabbit's eye. These results indicated that acetazolamide microsponges in situ gel have potential ability for ophthalmic delivery.

Idiopathic intracranial hypertension: adult versus pediatric patients

Idiopathic intracranial hypertension (IIH), also known as benign intracranial hypertension or pseudotumor cerebri, is characterized by increased intracranial pressure secondary to unknown causes. IIH affects both adults and children but predominately young obese females of child-bearing age. IIH gives rise to headache, visual disturbances, and symptoms of raised intracranial pressure. The pathophysiology of IIH remains elusive; postulations include obesity-related hormonal changes, obstruction of the central venous sinus, and hereditary causes. Diagnosing IIH is based on modified Dandy criteria. Diagnosis in children is challenging as symptoms and presentations vary; atypical and delayed presentations are not uncommon. Treatment for IIH includes oral acetazolamide or lumbar puncture; surgical treatment with shunts and optic nerve sheath fenestration is reserved for complicated and recurring cases. Treatment options for children are limited and associated with considerable risks and side effects. Vision loss is debilitating and occurs in 10% of IIH patients. A thorough and collaborative approach in managing IIH is needed. This study reviews the epidemiology, clinical presentation, diagnosis, and management of IIH in adults and pediatric patients.

Effect of hyperbaric oxygen treatment in central retinal artery occlusion

Central retinal artery occlusion (CRAO) is a rare and serious ophthalmologic emergency with a bad prognosis. Hyperbaric oxygen (HBO2) treatment has been reported to improve visual acuity of CRAO patients. However, there are unknown variables for HBO2 treatment such as initiation period, number of sessions and efficacy. In this study, we aimed to investigate efficacy of HBO2 treatment in CRAO patients. Patients who had been diagnosed with CRAO and referred to our Hyperbaric Oxygen Treatment Unit with the indication of HBO2 treatment were included in the study. Patient demographics, their systemic diseases, best-corrected visual acuity (BCVA) and the time of visual loss were recorded. Oral acetazolamide and topical beta blocker treatments as well as HBO2 treatments were administered to patients as soon as possible. Patients received 20 treatments as standard. Visual acuity was examined and recorded following each HBO2 treatment administration. 10 eyes (five right, five left) of 10 patients) were included in the study. While average visual acuity was LogMAR 3 before the treatment, it was measured as LogMAR 1.8 on average after treatment (P ⟨ 0.05). None of the patients were observed to have neovascular glaucoma. HBO2 treatment is an efficacious method with few side effects and can be used in the treatment of CRAO patients. During acute and subacute periods a certain number of HBO2 treatment sessions may be beneficial. Stopping treatments before eight completed HBO2 sessions for a patient who did not show improvement until that time may miss a patient who would have benefited from HBO2 treatment.

Acetazolamide Reduces Retinal Inner Nuclear Layer Thickness in Microcystic Macular Edema Secondary to Optic Neuropathy

Optic neuropathy (ON) is commonly complicated by microcystic macular edema (MME), that is, small vertical cystoid spaces in the inner nuclear layer (INL) of the macula. We performed a retrospective consecutive case series of 14 eyes from 11 patients with ON and MME that were treated with oral acetazolamide, acting on cellular water transport. Contralateral eyes without MME were used as controls. Segmentation of images obtained with OCT was used to determine changes of individual retinal layer thickness during treatment. Retinal INL thickness consistently decreased in all eyes after 2–3 weeks of treatment. Recurrence of MME was observed after treatment cessation. No significant change of retinal thickness was found in contralateral unaffected eyes. Visual function did not change with treatment. Acetazolamide significantly improved the MME in eyes with ON. However, visual function did not. Acetazolamide is a treatment option for MME associated with ON but without an impact on the visual function.

Acute primary angle-closure in Sturge-Weber syndrome

PurposeSturge-Weber syndrome (SWS) is a neurocutaneous disorder characterized by facial cutaneous venous dilatation (port-wine stain), leptomeningeal angioma, and ocular abnormalities. Here we report a case of SWS who experienced acute primary angle-closure in the same side of the nevus flammeus. ObservationsA 64-years-old female patient with SWS port wine stain on the left side of her face was referred to our ER for acute primary angle-closure (PAC). The IOP was 64 mmHg in the left eye (12 mmHg in OD) and the visual acuity was 20/100. The acute PAC was aborted after medical treatment with intravenous Mannitol and oral Acetazolamide, but laser iridotomy (LI) was not performed because of the risk of bleeding. After the acute episode, her IOP remained stable in midteen under 3 topical medications. However, the patient reported several subacute attacks in the following month. We arranged phacoemulsification and intraocular lens (IOL) implantation two months after the initial PAC attack. The post-op condition was smooth with 20/20 visual acuity, and the angle opened dramatically on anterior segment optical coherence tomography (AS-OCT). Her IOP was around 13 mmHg without medication and there was no more acute PAC attack. ConclusionsSWS with ipsilateral acute PAC has seldom been reported. Lens extraction and IOL implantation can be an option in treating such patients since conventional laser iridotomy may cause bleeding.