The role of carbonic anhydrase inhibitors in the management of macular edema

Details

Serval ID
serval:BIB_520D5ABBD9B8
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Title
The role of carbonic anhydrase inhibitors in the management of macular edema
Journal
Documenta Ophthalmologica
Author(s)
Wolfensberger  T. J.
ISSN
0012-4486 (Print)
Publication state
Published
Issued date
1999
Volume
97
Number
3-4
Pages
387-97
Notes
Journal Article
Review
Abstract
Medical treatment of cystoid macular edema (CME) with carbonic anhydrase inhibitors has been known for over a decade. Initial observations were based on experimental data which suggested that acetazolamide can increase fluid absorption across the retinal pigment epithelium. Carbonic anhydrase inhibitors (CAI) have also been shown to have other direct effects both on retinal and retinal pigment epithelial cell function by inducing an acidification of the subretinal space, a decrease of the standing potential as well as an increase in retinal adhesiveness. It is thought that acidification of the subretinal space is finally responsible for the increase in fluid resorption from the retina through the RPE into the choroid. Several clinical studies have suggested that patients with cystoid macular edema due to retinitis pigmentosa and uveitis may react more favorably to CAI treatment than other etiologies such as diabetic maculopathy or macular edema after retinal vein occlusion. The present working hypothesis is that diffuse leakage from the RPE responds more readily to CAI treatment than leakage from retinal vessels. This may be due to the modulation of membrane- bound CA IV in the RPE which may have lost its polarised distribution in the presence of macular edema. A normal clinical starting dose of CAI is 500 mg/day which should be continued for at least one month to see an effect. This dose may be reduced by the patients over the course of therapy. Metaphylaxis to the drug may occur with a rebound of the edema despite continuation of treatment.
Keywords
Acetazolamide/administration & dosage/*therapeutic use Carbonic Anhydrase Inhibitors/administration & dosage/*therapeutic use Carbonic Anhydrases/metabolism Cell Membrane Permeability/drug effects Choroid/metabolism/pathology Exudates and Transudates/drug effects/metabolism Fluorescein Angiography Fundus Oculi Humans Hydrogen-Ion Concentration/drug effects Intracellular Fluid/enzymology Macular Edema, Cystoid/diagnosis/*drug therapy/enzymology Pigment Epithelium of Eye/enzymology
Pubmed
Web of science
Create date
28/01/2008 14:05
Last modification date
03/03/2018 17:12
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