Acetazolamide, Metabolic Acidosis, and Intraocular Pressure

Bietti, G. B.; Virno, M; Pecori-Giraldi, J; Pellegrino, N.

doi:10.1016/0002-9394(75)90520-6

Cited by 29 publications

(10 citation statements)

References 3 publications

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“…In our case, the mechanism of acute IOP lowering is likely multifactorial resulting from intraoperative anesthesia, large fluctuations in systemic blood pressure and paO 2 , and administration of hyperosmotic sodium bicarbonate [4, 7]. …”

Section: Discussionmentioning

confidence: 99%

“…Drastic hemodynamic shifts during CABG can cause reduced blood flow to the ciliary body and decrease episcleral venous pressure [3]. In this setting of decreased aqueous production, the administration of intravenous anesthesia and hyperosmotic medications such as intravenous sodium bicarbonate can offset the balance of pressure homeostasis in the eye [4]. Interestingly for our patient, the hypotony resolved by postoperative day 1 with correction of the systemic blood pressure and arterial blood gas.…”

Section: Introductionmentioning

confidence: 87%

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Acute Onset Ocular Hypotony after Coronary Artery Bypass Surgery

Ahmed

Tai

Schmutz

et al. 2017

Case Rep Ophthalmol

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Importance: The purpose of this case report is to evaluate risk factors associated with post-coronary artery bypass graft (CABG) ocular hypotony compared to post-CABG ischemic optic neuropathy. Observations: The patient described here is a single case at the University of California, Irvine Medical Center, from July 2016. This case demonstrates the rare incidence of acute post-CABG ocular hypotony and vision loss in a patient with prior history of optic atrophy. Both vision loss and hypotony resolved completely to baseline without intervention within 3 days postoperatively. Conclusions and Relevance: Severe anemia and large fluctuations in central venous pressure and blood pressure can occur in any patient undergoing CABG surgery. These hemodynamic shifts can cause transient ischemia to pressure controlling systems such as the ciliary body and reduce episcleral venous pressure. Other risk factors for acute hypotony in the setting of CABG surgery also include the use of hypertonic agents, cardiopulmonary bypass, and intravenous anesthesia.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 87%

Acute Onset Ocular Hypotony after Coronary Artery Bypass Surgery

Ahmed

Tai

Schmutz

et al. 2017

Case Rep Ophthalmol

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“…269 The IOP-lowering affect of CAIs may be enhanced by the metabolic acidosis they can cause. 270 Acetazolamide is more likely to cause clinically relevant systemic acidosis than methazolamide at therapeutic doses. 271 This may be one of the reasons that acetazolamide at full doses lowers IOP better than full doses of methazolamide.…”

Section: Carbonic Anhydrase Inhibitorsmentioning

confidence: 99%

Medications Used to Treat Glaucoma

Schacknow

Samples

2010

The Glaucoma Book

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ConclusionOptimal therapy for glaucoma would involve IOP control throughout the 24-h period. However, not all therapies are equally efficacious at all times of the day and night. Understanding of the mechanisms of action of different therapies, along with the knowledge of the circadian changes in aqueous humor dynamics, allows us to predict the therapies that will provide the most consistent IOP reduction. As well, understanding of aqueous humor dynamics may help in the development of future therapies with consistent 24-h IOP control. Bibliography

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“…Whether extraceUular acidosis, which follows acetazolamide intake, relates to its effects on secretion of aqueous humor or CSF is debatable. In humans, intraocular pressure is lowered by plasma acidosis following administration of Ca C12 or ascorbic acid intake (2). These anions may have independent effects on either the HCO3-or Na+K + -stimulated ATPase.…”

Section: Commentmentioning

confidence: 99%

“…Maren calculated that in the CSF and aqueous humor of the dogfish, squalus acanthias, the rate of HCO3-formation is great enough to account for a major fraction of Na + transport (17,20). Davson, however, has rejected these postulations beceause acetazolamide fails to (1) reduce Na 22 turnover in the eye (8) as K in, arid (2) disturb Na + levels in steady-steady aqueous tumor or CSF (7,8). Further, although HCO3-is found in excess in plasma in aqueous humor or CSF in some mammalian species, and in deficit, relative to plasma, in others including man, the carbonic anhydrase inhibitors result in universal and unequivocal reduction in the rate of aqueous humor (1), and CSF formation (17) in all animal species.…”

Section: Introductionmentioning

confidence: 99%

Bicarbonate ATP-ase in ciliary body and a theory of Diamox effect on aqueous humor formation

Cotlier

1979

Int Ophthalmol

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Bicarbonate was found to stimulate ATP breakdown by rabbit or cat ciliary body-iris homogenates. Maximum HCO3- stimulation of ATPase with Tris-Hepes buffer occured at pH 8.0. Acid pH and chloride ions in the media reduced the activity of the HCO3--stimulated ATPase. The Km for ATP was 0.55 mmolar and for HCO3-, 20 mmlar. HCO3- ATPase was not inhibited by acetazolamide added to in vitro. It is postulated that ATPase represents the linkage step of energy donor mechanism and active CT secretion in acid aqueous humors (human, cat.) or HCO3- secretion in alkaline aqueous humor (rabbit, guinea pig). Inhibition of Cl- or HCO3- secretion by acetazolamide results from decreased intracellular HCO3- levels which, in turn, reduces the stimulation of the HCO3- ATPase.

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Acetazolamide, Metabolic Acidosis, and Intraocular Pressure

Cited by 29 publications

References 3 publications

Acute Onset Ocular Hypotony after Coronary Artery Bypass Surgery

Acute Onset Ocular Hypotony after Coronary Artery Bypass Surgery

Medications Used to Treat Glaucoma

Bicarbonate ATP-ase in ciliary body and a theory of Diamox effect on aqueous humor formation

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