Intraocular and intracranial pressure in glaucoma patients taking acetazolamide

Abstract

The alternative mechanical theory of glaucoma, in which an increased pressure difference across the lamina cribrosa (difference between intraocular and intracranial pressure; IOP and ICP), rather than solely an elevated IOP, leads to structural and functional vision loss, is still controversial. If the theory is true, a drug that simultaneously lowers both the IOP and ICP may be ineffective. The aim of this study was to determine how acetazolamide (AAZ; a drug prescribed in glaucoma that aims to lower the IOP) affects both IOP and ICP in glaucoma patients and to compare the magnitude and time course of the induced pressure changes with those of healthy subjects not taking AAZ. IOP and noninvasive ICP (measured through emissions from the ear) were measured in 20 glaucoma patients taking 125 mg of AAZ twice daily. Measurements were taken for 30 minutes before taking the drug and for 2 hours post-ingestion. Comparisons were made with 13 age-similar controls. After 12 hours with no anti-glaucoma medication, AAZ did not further reduce IOP in glaucoma patients compared to controls (P = 0.58) but did reduce ICP compared to controls (P = 0.035), by approximately 4 mmHg. Our findings suggest that there are periods during the day when the pressure difference across the lamina cribrosa is larger in case of AAZ use. Future studies should focus on improving the noninvasive ICP testing, different doses and dosing schedules of AAZ, and the time course of IOP in glaucoma patients not taking AAZ.

Rebound Intracranial Hypertension

“…If conservative measures are not sufficient, additional interventions include the use of oral pharmacological agents, such as acetazolamide [ 3 •]. Acetazolamide is a carbonic anhydrase inhibitor that reduces ion and water transport across the choroid plexus, thereby reducing CSF production and lowering intracranial pressure [ 32 ]. It has been utilized in managing other forms of intracranial hypertension and may have potential utility in treating RIH.…”

Formulation and evaluation of ophthalmic microemulsion for enhanced topical administration of brinzolamide

“…Glaucoma can cause vision loss and, if left untreated, lead to complete blindness. Intraocular pressure is the main cause of the development of glaucoma due to the increased production of aqueous humour (Loiselle et al, 2020). Brinzolamide (BZD) is used as the first-line drug for the treatment of glaucoma (Silver and Group, 2000).…”

Acetazolamide-Induced Periorbital Myokymia: A Case Report

“…Acetazolamide is primarily used in the treatment of glaucoma, due to its role in decreasing intraocular pressure by lowering the production of aqueous humor. Because it blocks choroid plexus enzymes and reduces cerebrospinal fluid (CSF) production, it is also used to treat excessive ICP [ 7 ].…”