Send to

Choose Destination
J Glaucoma. 2019 Jan 7. doi: 10.1097/IJG.0000000000001189. [Epub ahead of print]

The Effect of Acetazolamide and Weight Loss on Intraocular Pressure in Idiopathic Intracranial Hypertension Patients.

Author information

*Neuro-Ophthalmology, New York Eye and Ear Infirmary and Icahn School of Medicine at Mount Sinai, New York, New York †Dept. of Electrical and Computer Engineering, The University of Iowa, Iowa City, IA ‡Iowa City VA Health Care System and Iowa City VA Center for the Prevention and Treatment of Visual Loss, Iowa City, IA.



Acetazolamide (ACZ) lowers IOP, acutely in normal eyes and both acutely and chronically in eyes with glaucoma, and cerebrospinal fluid pressure (CSFp), chronically in patients with idiopathic intracranial hypertension (IIH). We hypothesize chronic daily ACZ would significantly reduce IOP and contribute to a translaminar pressure gradient change reflected by alteration in the CSFp-IOP difference and the deformation of the neural canal in patients with IIH and no glaucoma.


Prior to randomization to ACZ or placebo treatment for six months, 165 participants in the IIH Treatment Trial had evaluations that included Goldmann applanation, CSFp measurement, and OCT determination of the neural canal deformation. These measures were repeated at the six-month outcome.


The IOP was not significantly decreased from baseline at 1, 3 or 6 months in eyes in both treatment groups. At month six, the amount of ACZ or weight modification did not correlate with any IOP change. The six-month mean change in neural canal deformation was 0.96 and -0.04 (P = 0.001) and in CSFp was -128▒mm H2O and -38▒mm H2O (P = 0.001), but CSFp-IOP difference change was not significant, in the ACZ and placebo groups, respectively.


ACZ does not reduce the IOP in eyes without glaucoma but does decrease the pathological elevated CSFp, providing evidence that normal systems can compensate for chronic medication effects. The CSFp-IOP is not a direct marker of translaminar pressure gradient and the ACZ normalization of the neural canal deformation appears due to CSFp reduction alone.

Supplemental Content

Full text links

Icon for Wolters Kluwer
Loading ...
Support Center