Original article
Topical Dorzolamide for the Treatment of Cystoid Macular Edema in Patients With Retinitis Pigmentosa

Data from this study were presented in part at the Annual Meeting of the Association for Research in Vision and Ophthalmology, Fort Lauderdale, Florida, May 1, 2005, and the Annual Meeting of the American Academy of Ophthalmology, Chicago, Illinois, October 16, 2005.
https://doi.org/10.1016/j.ajo.2005.12.030Get rights and content

Purpose

To determine if topical dorzolamide, as observed with the use of systemic acetazolamide and methazolamide, would be effective in treating cystoid macular edema (CME) in patients with retinitis pigmentosa (RP).

Design

Prospective, nonrandomized clinical trial.

Methods

setting: Institutional. patients: Fifteen patients with CME and RP. intervention: A baseline visual acuity and optical coherence tomography (OCT) measurements were obtained in all patients. Each one of them was then treated with topical dorzolamide, three times a day, for at least four weeks in both eyes. main outcome measures: Significant decrease in “foveal thickness” (more than 16%) and “foveal zone thickness” (more than 11%), as measured by OCT.

Results

Thirteen (87%) of 15 patients showed a significant decrease in retinal thickness in at least one eye after use of topical dorzolamide for at least four weeks. Five patients (33%) demonstrated improvement in both eyes. All patients, except one, who responded showed the effect within four weeks, but were monitored for a period of two to nine months (average 4.5 months). Four patients (31%) who showed an initial improvement in macular edema showed worsening with continued treatment.

Conclusions

The present study documents the potential efficacy of topical dorzolamide for treating CME in patients with RP. We observed that some patients may show a “rebound phenomenon” with continued use of the medication; hence, there is a need for careful follow-up in patients being treated.

Section snippets

Methods

This study was approved by the internal local institutional review board at the University of Illinois. An informed consent was obtained from all participating subjects, and the study was conducted in accord with The American Health Insurance Portability and Accountability Act (HIPAA) regulations.

All patients seen by the authors within an age range with various genetic subtypes of RP or Usher syndrome type 2 and associated CME were considered for participation in this prospective study. The

Results

Clinically, all fifteen patients showed foveal cysts in at least one eye, with 12 patients showing them in both eyes. The presence of cysts had been documented for a period of at least one to 27 years by one of the authors (G.A.F.) in 12 patients. In three others (patients 1, 3, and 13), cysts were seen on their first visit to the clinic, and soon after, they were enrolled in the study.

Visual acuity improved by seven letters or more from the baseline value in at least one eye in three (20%) of

Discussion

Although the exact mechanism of CME in RP is not known, it has been theorized that, partly, it may be due to an abnormality in retinal pigment epithelial cell polarity, whereby the retinal pigment epithelium cells are unable to effectively pump out ions and, hence, fluid from the outer retina.8 It is postulated that carbonic anhydrase inhibitors may be exerting their therapeutic effect by restoring the polarity and, hence, the function of the retinal pigment epithelium cells.8

On this basis, the

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    This study was supported by grants from the Foundation Fighting Blindness, Owings Mill, Maryland, and the Grant Healthcare Foundation, Chicago, Illinois, and by an unrestricted departmental grant from Research to Prevent Blindness, Inc, New York, New York.

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