Relationships among systemic blood pressure, intraocular pressure, and open-angle glaucoma

Several vascular factors, including systemic hypertension (or high blood pressure [HBP]), ocular perfusion pressure, and nocturnal hypotension, have been identified as risk factors for the development and progression of glaucoma. The results of epidemiologic studies of these factors and their relationships to intraocular pressure (IOP) and open-angle glaucoma (OAG) have been contradictory. Inconsistent definitions of HBP and OAG, inconsistent design, and differing population characteristics within these studies have obfuscated definitive conclusions. Here, we review the relationships among blood pressure, IOP, and OAG.     

Relationship between systemic hypertension,perfusion pressure and glaucoma: A comparative study in an adult Indian population

Aims:

To study the relationship between blood pressure (BP), intraocular pressure (IOP), mean ocular perfusion pressure (MOPP) and primary open angle glaucoma (POAG) in patients with hypertension and compare it to a control group of normotensives.

Design:

Cross-sectional observational study.

Materials and Methods:

A total of 108 subjects with primary hypertension and 100 age-matched controls without hypertension were enrolled for the study. IOP measurement using Noncontact Tonometer and dilated fundus evaluation using + 90 D lens were done for all cases. Single recording of BP was taken. Gonioscopy, Humphrey''s central visual fields, optical coherence tomography and pachymetry were done for all subjects with IOP > 21 mm Hg or C: D ratio ≥ 0.5 or asymmetry of > 0.2.

Statistical Analysis:

Univariate and multivariate multinomial regression models were used to determine the association between covariates and risk of glaucoma or glaucoma suspect.

Results:

There was no difference in the glaucoma status between subjects with and without hypertension. Subjects on antihypertensive medications were 1½ times more likely to have suspicious glaucoma (odds ratio [OR] =1.56] and nearly twice as likely to have POAG (OR = 1.85). In addition, we found a 31% and 12% reduction in risk of having POAG (95% confidence interval [CI] =13–45%, P = 0.001) and glaucoma suspect (95% CI = 2–21%, P = 0.03) respectively with every 1 mm Hg increment in MOPP.

Conclusion:

Subjects on antihypertensive medications are more likely to have either glaucoma or glaucoma suspect, and higher ocular perfusion pressure offers relative protection from glaucomatous damage.     

同步监测青光眼患者24h眼压与血压的意义

青光眼是世界范围内致盲和引起视力损害的主要眼病,也是不可逆性致盲性眼病之一.眼压是青光眼发生发展的重要危险因素,但除眼压外,血压在青光眼进展引起的影响也不可忽视.眼灌注压是血压和眼压的差值,可调节视神经的血液供应.眼压、血压、灌注压在青光眼发生发展中有一定相关性.本文通过对眼压和血压在青光眼中的影响以及24 h眼压和血...     

眼灌注压波动对青光眼患者病情的影响

目的：探讨眼灌注压波动对青光眼患者病情的影响。

方法：选取我院2013-01/2015-06收治的40例原发性开角型青光眼患者为观察组,同期我院患者家属40例为对照组。监测受试者24h的眼压、血压与眼灌注压的昼夜波动情况,得出收缩期眼灌注压(SOPP)、舒张期眼灌注压(DOPP)和平均眼灌注压(MOPP)。采用Pearson线性相关性分析MOPP昼夜波动与杯盘比、视野平均缺失(MD)及图形标准差(PSD)的相关性。

结果：观察组患者全天和夜间的MOPP、SOPP和DOPP波动均大于对照组(P<0.05)。MOPP 昼夜波动与MD存在显著的负相关(r=-0.389,95%CI：-0.612～-0.082; P=0.011); 与PSD呈正相关(r=0.512,95%CI：0.139～0.782; P=0.008); 与垂直杯盘比之间无相关性(r=0.115,95%CI：0.056～0.369; P=0.355)。

结论：原发性开角型青光眼患者眼灌注压波动可反映病情的严重程度,可能会导致疾病向严重方向发展,因此通过行24h的灌注压的监测可帮助我们了解原发性开角型青光眼患者全天的眼部血流状态,了解病情发展。     

原发性开角型青光眼患者不同体位眼灌注压昼夜波动趋势分析

Objective To characterize the circadian fluctuation of ocular perfusion pressure (OPP) in different position  in patients with newly diagnosed, untreatedprimary open-angle glaucoma（POAG）. Design Cohort study. Participants Nineteen patients with POAG (19 eyes) and eighteen healthy controls (18 eyes) were included in the Peking University Shenzhen Hospital. Methods POAG patients and healthy controls were included and underwent 24-hour monitoring of IOP and blood pressure. On 10:00, 14:00, 18:00 and 22:00 o’clock in the daytime, all the subjects were monitored in sitting position, then POAG patients were monitored again after lying down for 5 minutes. On 2:00, 5:00 and 7:00 o’clock at night all the subjects were monitored in supine position, then POAG patients were monitored again after sitting for 5 minutes. Calculating the mean ocular perfusion pressure (MOPP), the systolic ocular perfusion pressure (SOPP) and diastolic perfusion pressure (DOPP) by the formula and analyzing the data. Main Outcome Measures  MOPP, SOPP, DOPP. Results In both groups of habitual position (sitting position in day and supine position in night), the nocturnal MOPP, SOPP and DOPP were lower than diurnal. In both groups, the nocturnal MOPP was lower than diurnal in habitual position (POAG group t=4.092, P=0.000; healthy group t=4.513, P=0.000). However, there was no obvious difference between those two groups (t=-0.973, P=0.350). POAG group had higher 24-hour fluctuation of MOPP (t=2.204, P=0.039), higher nocturnal fluctuation of SOPP (t=3.097, P=0.018), higher nocturnal and 24-hour fluctuation of DOPP than healthy group, all the differences had statistical significance (all P<0.05).  In POAG group , there was no statistical difference between the nocturnal MOPP and the diurnal MOPP in sitting position or in supine position of 24 h (all P>0.05). POAG group had higher 24-hour mean MOPP in sitting position than in supine position, the difference had statistical significance (t=4.306, P=0.001).  Comparing the MOPP of  POAG group  in habitual position with in sitting position of 24 h, there was no statistical difference(t=-2.101, P=0.080). However, POAG group had higher 24-hour mean MOPP in habitual position than in supine position of 24 h, the difference had statistical significance (t=2.707, P=0.035). Conclusions There circadian fluctuation of  OPP in different position in POAG pations can not be treated as the same. The nocturnal MOPP  was lower than diurnal in habitual position, but there was no obvious difference in the 24h-sitting position and 24h-supine position.  (Ophthalmol CHN, 2017, 26: 20-25）     

原发性开角型青光眼与24h眼压及眼灌注压的研究进展

原发性开角型青光眼是一类早期无明显临床症状,但随病情进展将导致不可逆的视神经损害及视野缺损的致盲性眼病。眼压是原发性开角型青光眼诊断及评定治疗效果的简单而又重要的指标。临床上,一些治疗中的原发性开角型青光眼患者白天就诊时间所测眼压已达靶眼压,但视神经损害却仍在进展,研究表明可能与夜间眼压的升高、24 h较大的眼压波动及夜间眼灌注压的降低有关。因此,我们对原发性开角型青光眼与眼压及眼灌注压波动的相关文献予以综述,以更好的理解三者之间的关系。     

Clinical clues of vascular dysregulation and its association with glaucoma

Vascular dysregulation is a condition in which blood flow is not properly distributed to meet the demands of different tissues and could lead to overperfusion or underperfusion. Vascular dysregulation can be primary (occurring alone) or secondary (associated with other disorders, usually autoimmune diseases), and is caused by an imbalance between vasodilator and vasoconstrictor substances produced mainly locally by the vascular endothelium. In most circumstances of vascular dysregulation, the level of endothelin-1 is increased, leading to vasospasm. Vascular dysregulation is present in at least some subgroups of patients with glaucoma, and in these individuals it might have some important therapeutic consequences. In this article we review the evidence linking vascular dysregulation and glaucoma, and evaluate the clinical characteristics that might suggest the presence of vascular dysregulation in the glaucoma patient.     

国产与进口拉坦前列素滴眼液降眼压作用的短期效果比较

目的 比较国产与进口拉坦前列素滴眼液的短期降眼压效果。设计 随机、开放、平行对照的临床研究。 研究对象  原发性开角型青光眼患者和高眼压症患者42例。方法 对上述患者按所用药物的不同依随机表法分为A、B两组。A组28例（28眼）,滴用国产拉坦前列素滴眼液（特力洁）,B组14例（14眼）,滴用进口拉坦前列素滴眼液（适利达）,均为每日1次,每次1滴,共28天。受试者于入组当日及用药后第28天8:00、11:00、14:00、16:00测眼压,第7、14、21天则于8:00测眼压。眼压测量采用Goldmann压平眼压计,测量3次取平均值。裂隙灯显微镜观察角膜、虹膜、晶状体情况。主要指标  眼压值。结果 A组用药前眼压为（23.99±1.51）mm Hg, 用药后1～4周眼压分别为（18.04±1.27）mm Hg、（17.75±1.43）mm Hg、（17.63±1.50）mm Hg、（17.49±1.47）mm Hg,用药后眼压明显下降,与用药前相比差异有统计学意义（F=105.72,P=0.000）。B组用药前眼压为（24.37±1.55）mm Hg,用药后1～4周眼压分别为（17.91±1.35）mm Hg、（17.71±1.39）mm Hg、（17.55±1.34）mm Hg、（17.44±1.17）mm Hg,与用药前相比,用药后眼压明显下降,差异有统计学意义（F=67.85 P=0.000）。A、B两组用药前眼压比较无显著性差异（P=0.43）,用药后1～4周两组眼压比较无显著性差异（P值分别为0.76、0.93、0.86、0.89）。入组当日8:00、11:00、14:00、16:00  A、B两组眼压之间的比较无显著性差异（P值分别为0.46、0.44、0.50、0.31）,用药后28天8:00、11:00、14:00、16:00  A、B两组眼压之间的比较无显著性差异（P值分别为0.89、0.85、0.94、0.98）。用药28天时两组患者角膜、虹膜、晶状体均无异常改变。结论  本文的小样本、短期研究显示,国产拉坦前列素与进口拉坦前列素均能有效降低原发性开角型青光眼及高眼压症患者的眼压,两者之间的降眼压效果无显著差异。（眼科, 2012, 21: 111-114）     

Analysis of aerobic exercise influence on intraocular pressure and ocular perfusion pressure in patients with primary open-angle glaucoma: A randomized clinical trial

Purpose:To investigate the change pattern of ocular perfusion pressure (OPP) and intra-ocular pressure (IOP) after short-term and long-term aerobic exercise.Methods:In this prospective, single-masked, randomized clinical trial, 123 patients with a primary open angle glaucoma that locally used prostaglandin analog alone were randomly divided into the exercise and control groups. In the short-term study, all individuals underwent a cycling exercise at moderate intensity (20% Wmax for 10 minutes) and high intensity (60% Wmax for 5 minutes). During the long-term study, the exercise group is characterized by regular jogging exercise lasting for 30 minutes during 6: 00–10: 00 in the morning for 3 months, with the exercise frequency of at least 20 times per month, and with the intensity reflected by the target heart rate. The control group is designed as a group with irregular exercise.Results:After short-term aerobic exercise, IOP significantly decreased, whereas the ocular perfusion pressure (OPP) significantly increased. The decreasing amplitude of IOP is related to the baseline of IOP, the intensity of exercise, gender, and so on. After 3 months of long-term exercise, the changes in the IOP level of the exercise group indicated a decreasing trend.Conclusion:The significant decrement of IOP and the increment of OPP suggest that aerobic exercise is beneficial for patients with primary open-angle glaucoma and appropriate aerobic exercise is appropriate in treating glaucoma patients.Trial registration:ChiCTR, ChiCTR-TRC-10001055. Registered one October 2010-Retrospectively registered, http://www.chictr.org.cn/showproj.aspx?proj = 8483     

Efficacy of dorzolamide in improving ocular blood flow in patients with open-angle glaucoma: The Indian carbonic anhydrase inhibitor trial

Purpose:Impaired ocular blood flow is an important risk factor in the pathogenesis of open-angle glaucoma (OAG). Studies have reported that dorzolamide 2% may be effective in improving ocular blood flow (OBF) in OAG patients. The objective of this study was to determine the efficacy of dorzolamide 2% (DORZOX, Cipla Ltd.) in improving retrobulbar blood flow in an Indian setting.Methods:The study was conducted as an interventional pilot project in 24 healthy subjects and 19 OAG patients. Baseline OBF measurements were done for all glaucoma patients with color Doppler imaging (CDI). Baseline ocular perfusion pressure (OPP) was calculated for all participants. Glaucoma patients were given dorzolamide 2% thrice daily for 12 weeks. The primary efficacy endpoints were mean changes in the CDI parameters of the retrobulbar vessels and OPP posttreatment. The secondary endpoint was mean change in the intraocular pressure (IOP) and adverse events, if any.Results:In comparison to healthy subjects, glaucoma patients displayed significantly reduced baseline OPP (P = 0.002). Treatment with dorzolamide 2% for 12 weeks led to a significant increase in OPP (P < 0.001) and a significant increase in end diastolic velocity (EDV) in all major ophthalmic arteries like ophthalmic artery (OA), central retinal artery (CRA), and short posterior ciliary artery (SPCA) (P < 0.001, P = 0.04, and P = 0.0075, respectively). A significant reduction in the intraocular pressure (IOP; P = 0.007) was observed posttreatment, with no adverse events reported.Conclusion:Dorzolamide 2% significantly improved parameters such as the EDV and OPP in major ophthalmic arteries. This pilot study shows promising results on using dorzolamide for treating Indian patients with OAG.     

POAG患者习惯性体位眼压及眼灌注压昼夜波动趋势的研究

目的：探讨初诊未行治疗的原发性开角型青光眼( prilary open angle glaucola,POAG)患者习惯性体位眼压及眼灌注压(ocular perfusion pressure,OPP)波动趋势,并验证由日间平均坐位及卧位眼压推导夜间峰值眼压的可行性。
　　方法：选取POAG患者19例19眼及正常对照组18例18眼,分别于10：00,14：00,18：00及22：00时行坐位眼压及血压监测,为验证由日间卧位眼压推导夜间峰值眼压的可行性,另对POAG组于卧位5 lin后再行监测。2：00,5：00及7：00行卧位监测,计算出OPP并行数据分析。由已知公式通过日间眼压计算夜间峰值眼压,并与实际值对比。
　　结果：24h习惯性体位下,POAG患者平均眼压及眼压波动均高于正常对照组(P<0.05),POAG组平均眼压峰值出现于凌晨5：00,对照组则为7：00。两组夜间眼压均值均大于日间,差异有统计学意义(P<0.05)。两组内习惯性体位平均眼灌注压( MOPP )均表现为夜间低于日间( P<0.05),而两组间 MOPP 无明显统计学差异( P>0.05)。POAG患者MOPP波动较对照组大,差异有统计学意义( P<0.05)。由两公式推导所得夜间眼压峰值均与所测值无明显统计学差异(P>0.05)。
　　结论：习惯性体位下POAG组及正常人的眼压峰值多出现在凌晨至上午,POAG患者的习惯性体位平均眼压及眼压波动均高于对照组。两组内夜间灌注压均较日间低,且POAG患者有更大的MOPP波动。由日间眼压推导夜间峰值眼压具有一定的可行性。     

颅内压与青光眼及其无创测量技术的研究进展

青光眼是世界上第二位致盲性眼病,第一位不可复性致盲性眼病。尽管眼压增高被认为是青光眼性视神经损害的主要危险因素,但是50%的原发性开角型青光眼患者的日常眼压正常,还有一些患者尽管眼压控制良好,但青光眼性视神经损害仍继续发展。这些现象无法用高眼压理论来解释,青光眼患者视神经损害的发病机制仍待探讨。目前国内外的一些研究表明：（1）视神经周围的生物力学的解剖结构包括眼内压,筛板和球后的脑脊液压力在原发性开角型青光眼的发病机制中发挥重要的作用;（2）正常眼压性青光眼患者的脑脊液压力比正常人低,而跨筛板压力差比正常人高;（3）高眼压症患者的脑脊液压力比正常人群高,而跨筛板压力差和正常人之间没有统计学意义。基于以上研究,本文就颅内压与青光眼性视神经损害之间关系的相关研究进展及临床上可行的无创颅内压测量方法作一综述。     

Nocturnal blood pressure and intraocular pressure measurement in glaucoma patients and healthy controls

Daytime and nocturnal intraocular pressure (IOP) values and systemic blood pressure (BP) values were compared in 60 non-glaucomatous controls, 54 glaucoma patients with normal visual field, and 46 glaucoma patients with visual field loss. The daytime IOP was measured with a Goldmann applanation tonometer and the nocturnal IOP with a Bio-Rad-Tono-Pen 2 . The BP was measured with either a mercury manometer or with a Meditech ABPM-02 Ambulatory Blood Pressure Monitor, which took BP readings at 60 minute intervals. A tendency towards increasing IOP and decreasing BP was detected in the non-glaucomatous controls, within normal limits, and pathological changes of IOP and BP were observed with a significantly high occurrence (5% > P > 2%; Pearson's ²-test) in the glaucoma group with visual field loss.     

青光眼药物对眼部血液循环的影响

尽管眼压被认为是青光眼发病的主要危险因素,越来越多的证据显示,眼部缺血也对青光眼发病起着重要作用。由于当前所用的许多青光眼药物对血管系统有影响,因此评价这些药物对眼部循环的作用有着重要意义。本文就6大类局部降眼压药物对眼血流的影响进行综述。     

不同血压段晚期青光眼眼压控制稳定后1年内视野分析

目的:分析眼压控制稳定的晚期青光眼术后1a内在不同血压段时视野进展情况.方法:记录晚期青光眼眼压正常患者的舒张期血压及眼压值,并分别做视野检查,通过AGIS评分法判断病程的进展.结果:随访1a,各试验组平均随访眼压值比较无差异;各组视野受损进展率有差异,血压偏低组视野受损进展比较快.结论:低血压是晚期青光眼病程中的危险因素之一.晚期青光眼患者如舒张期血压过低,视野有恶化趋势.     

Measuring and interpreting ocular blood flow and metabolism in glaucoma

There is a growing body of evidence suggesting that vascular dysfunction is related to several prominent ophthalmic diseases, including glaucoma. The vast majority of studies providing data on ocular circulation and disease pathophysiology use a relatively small number of complicated ocular blood flow imaging techniques. Although these imaging technologies are not commonly used in clinical settings, understanding the medical literature characterizing ocular blood flow requires familiarity with their methodology and function. This review highlights the imaging technologies most commonly used to investigate ocular blood flow, including color Doppler imaging, confocal scanning laser ophthalmoscopic angiography with fluorescein and indocyanine green dye, Canon laser blood flowmetry, scanning laser Doppler flowmetry, and retinal photographic oximetry. Each imaging technique's ability to define vascular function and reveal pathology is discussed as are limitations inherent to each technology. The ultimate goal of this review is to provide the physician with a clinically relevant foundation for differentiating the various ocular blood flow outcome measures often presented in the literature and determine how they are related to ocular health and disease.     

眼灌注压对人视乳头微循环的影响

目的 了解眼外负压吸引诱导的眼灌注压改变的条件下，正常人、原发性开角性青光眼(POAG)患者和正常眼压性青光眼患者(NTG)的视乳头微循环的变化，探讨视乳头局部自身调节的幅度。方法正常人8例，POAG患者10例和NTG患者7例，采用眼外负压杯吸引诱导眼压升高，负压增加的幅度为30s50mmHg，同时测量眼压。采用HRF测量视乳头处血流量。将基础状态下视乳头血流值作为基础值，当眼压升高到30mmHg和40mmHg时，分别测量这两点视乳头微循环的血流值，在40mmHg后解除负压吸引，测量负压吸引解除后1min、5min时视乳头微循环的血流值。结果 三组视乳头的基础血流量无明显差异。当眼压升高到30mmHg时，正常组的血流量仍维持稳定，但POAG组和NTG组明显下降，POAG组下降幅度超过25％，NTG组下降幅度超过45％。当眼压升高到40mmHg，正常组视乳头血流量也出现明显下降，其中0NHF下降约30％，POAG组和NTG组下降更明显，POAG组下降幅度超过50％，NTG组下降幅度超过65％。在解除负压吸引后1min，正常组血流量增加的幅度约为31％，POAG组增加约19％，NTG组无明显增加。在负压解除后5min，三组视乳头血流基本恢复到基础状态。结论 正常组视乳头微循环有一定范围的自身调节幅度，可以耐受眼灌注压一定程度的改变，POAG组和NTG组自身调节能力均有不同程度的损害。     

Pseudophakic glaucoma

Summary Pseudophakia by itself does not cause ocular hypertension. Pseudophakic glaucoma should be defined as glaucoma that would not be present in an eye if it were not pseudophakic. Ocular hypertension was noted in 15 (9%) of 166 pseudophakic eyes. Only 5 eyes (3%) had ocular hypertension requiring treatment. Three of these eyes (1.8%) had permanent ocular hypertension resulting in chronic pseudophakic glaucoma. This study shows that pseudophakic glaucoma is no more frequent than aphakic glaucoma. Secondary glaucoma in pseudophakic eyes is not always related to the presence of the lens.Pupillary block glaucoma and UGH syndrome are directly related to the lens. Secondary glaucoma by ghost cells and by pigment-dispersion are also in some cases directly related to the lens.