Retinal Autoregulation in Open-angle Glaucoma

Grunwald, Juan E.; Riva, Charles E.; Stone, Richard A.; Keates, Edwin U.; Petrig, Benno L.

doi:10.1016/s0161-6420(84)34091-x

Cited by 206 publications

(103 citation statements)

References 7 publications

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“…A sudden and substantial drop in IOP has been hypothesised to cause retinal vascular dysregulation and forward movement of the lamina cribrosa, leading to blockage of axonal transport and compression of the central retinal vein [55,56]. Decompression retinopathy is prevented by gradual reduction of IOP using the paracentesis before intraocular entry and the use of an infusion.…”

Section: Decompression Retinopathymentioning

confidence: 99%

Enhanced Trabeculectomy – The Moorfields Safer Surgery System

Khaw

Chiang²,

Shah³

et al. 2012

Developments in Ophthalmology

102

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Trabeculectomy with anti-fibrotic treatment is still the most popular incisional procedure for glaucoma filtration surgery (GFS) worldwide. The advent of anti-fibrotic agents reduced failure due to scarring but resulted in increased complications. Advances in trabeculectomy surgery have been driven by the need to minimise the risk of: (1) complications and (2) surgical failure. This chapter cov-ers preoperative, intraoperative and postoperative strategies, which improve the outcome of GFS. Strategies to reduce the risk of complications centre on the prevention of postoperative hypotony by minimising the risk of overdrainage, postoperative wound leaks and poor bleb morphology. Surgical techniques to reduce the risk of postoperative fibrosis by the use of anti-fibrotic agents (including mitomycin C) are discussed in detail. These techniques are based on a combination of considerable clinical experience, observation and laboratory research. The need to address pre-, intra-and postoperative issues in each individual patient is emphasised. These changes are embod-ied in the system we call the 'Moorfields Safer Surgery System' . The use of these strategies has consid-erably reduced the incidence of major complications including hypotony, cystic blebs and endophthalmitis in practices around the world. Most of these techniques are simple, require mini-mal equipment and can be easily mastered. They are associated with an improvement in overall outcome and it is hoped that this chapter will help the reader benefit from these advances.

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Section: Decompression Retinopathymentioning

confidence: 99%

Enhanced Trabeculectomy – The Moorfields Safer Surgery System

Khaw

Chiang²,

Shah³

et al. 2012

Developments in Ophthalmology

102

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“…6,16 Vascular autoregulation, defined as the capacity of a vascular bed to maintain a constant blood flow despite variations in perfusion pressure, is compromised in glaucoma. 17,18 Flicker-induced vasodilation of retinal and ONH vessels is appreciably reduced in glaucoma patients, indicating important neurovascular coupling defects in this disease. 19,20 A relationship between glaucoma and endothelin, a potent vasoactive peptide, has also been established.…”

mentioning

confidence: 99%

Acetylcholinesterase Inhibition Promotes Retinal Vasoprotection and Increases Ocular Blood Flow in Experimental Glaucoma

Almasieh

Macintyre

Pouliot

et al. 2013

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. A clear correlation between vascular deficits and retinal ganglion cell (RGC) loss in glaucoma has not yet been established. The question arose as to whether there is loss of inner retinal vessels following intraocular pressure (IOP) increase and, if so, whether it occurs prior to, concomitantly with, or after RGC death. We also sought to establish whether galantamine, an acetylcholinesterase inhibitor that promotes RGC survival, can protect the retinal microvasculature and enhance blood flow in experimental glaucoma. METHODS. Ocular hypertension was induced in BrownNorway rats by injection of hypertonic saline into an episcleral vein. Retinas were processed for simultaneous visualization of the retinal microvasculature and RGCs in glaucomatous and control eyes. Retinal blood flow was examined by quantitative autoradiography using N-isopropyl-p-[14 C]-iodoamphetamine. Vascular reactivity was further assessed using an in vitro retinal microvasculature preparation.RESULTS. Substantial loss of retinal capillaries was observed after induction of ocular hypertension. The onset of both microvasculature and RGC loss occurred early and proceeded at a similar rate for at least 5 weeks after the initial damage. Systemic administration of galantamine preserved microvasculature density and improved retinal blood flow in glaucomatous retinas. The vasoactive effects of galantamine on retinal microvessels occurred through activation of muscarinic acetylcholine receptors both in vitro and in vivo.CONCLUSIONS. The onset and progression of microvessel and RGC loss are concomitant in experimental glaucoma, suggesting a tight codependence between these cellular compartments. Early interventions aimed to protect the retinal microvasculature and improve blood supply are likely to be beneficial for the treatment of glaucoma.

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“…The effect of lOP on ocular blood flow has been studied using a variety of methods such as heated thermocouple, India ink, micro spheres, iodoantipyrine iodine-125, fluorescein angiography, laser Doppler velocimetry, blue field entopic phenomenon, tritiated iodoantipyrine, hydrogen clearance method and Doppler ultrasonography. [3][4][5][6][7][8][9][10][11] Many of these are invasive or even destructive, and are restricted to the investigation of animal models. Others are applicable to human evaluation, yet require the use of mydriatics, or may be affected by opaque optical medium.…”

mentioning

confidence: 99%