Rigidity of Retinal Vessel in Untreated Eyes of Normal Tension Primary Open-angle Glaucoma Patients

Oettli, A.; Gugleta, Konstantin; Kochkorov, Asan; Katamay, Robert; Flammer, Josef; Orgül, Selim

doi:10.1097/ijg.0b013e3181e666a1

Cited by 31 publications

(24 citation statements)

References 23 publications

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“…NTG patients may have some unknown structural weaknesses along the extra-ocular drainage pathway (in venous tonus, for instance) that may render them incapable to significantly buffer any change in the forces acting outside the globe. In fact, venous circulation in glaucoma patients -and specially NTG patients -has been proved to behave differently than in healthy individuals, ranging from different peripapilary vessel diameter [31] and rigidity [32] to significant decrease in prevalence of spontaneous venous phenomenon [33,34]. The degree of the impact of this vascular venous dysregulation on IOP and the extent to which it would interfere with the drainage of an otherwise normal IOP on NTG is not fully understood.…”

Section: Discussionmentioning

confidence: 99%

Intraocular pressure correlates with optic nerve sheath diameter in patients with normal tension glaucoma

Pinto

Vandewalle

Pronk

et al. 2011

Graefes Arch Clin Exp Ophthalmol

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Purpose 1. Identify differences in optic nerve sheath diameter (ONSD) as an indirect measure of intracranial pressure (ICP) in glaucoma patients and a healthy population. 2. Identify variables that may correlate with ONSD in primary open-angle glaucoma (POAG) and normal tension glaucoma (NTG) patients. Methods Patients with NTG (n046) and POAG (n061), and healthy controls (n042) underwent B-scan ultrasound measurement of ONSD by an observer masked to the patient diagnosis. Intraocular pressure (IOP) was measured in all groups, with additional central corneal thickness (CCT) and visual field defect measurements in glaucomatous patients. Only one eye per patient was selected. Kruskal-Wallis or Mann-Whitney were used to compare the different variables between the diagnostic groups. Spearman correlations were used to explore relationships among these variables. Results ONSD was not significantly different between healthy, NTG and POAG patients (6.09±0.78, 6.03±0.69, and 5.71±0.83 respectively; p00.08). Visual field damage and CCT were not correlated with ONSD in either of the glaucoma groups (POAG, p00.31 and 0.44; NTG, p00.48 and 0.90 respectively). However, ONSD did correlate with IOP in NTG patients (r00.53, p<0.001), while it did not in POAG patients and healthy controls (p00.86, p00.46 respectively). Patient's age did not relate to ONSD in any of the groups (p>0.25 in all groups). Conclusions Indirect measurements of ICP by ultrasound assessment of the ONSD may provide further insights into the retrolaminar pressure component in glaucoma. The correlation of ONSD with IOP solely in NTG patients suggests that the translaminar pressure gradient may be of particular importance in this type of glaucoma.

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Section: Discussionmentioning

confidence: 99%

Intraocular pressure correlates with optic nerve sheath diameter in patients with normal tension glaucoma

Pinto

Vandewalle

Pronk

et al. 2011

Graefes Arch Clin Exp Ophthalmol

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“…2 During recent years, however, additional risk factors, such as ocular and systemic circulation abnormalities, have been linked to the cause and progression of both POAG [3][4][5][6][7][8] and NTG, [9][10][11][12] and IOP reduction has been shown [13][14][15][16] to have a positive effect on disease progression in both conditions. Consequently, recent research [17][18][19][20] has recommended the abolishment of the terms POAG and NTG, proposing instead that POAG be considered a disease continuum extending from a predominantly IOP-dependent entity at one end (pure POAG) to a predominantly IOPindependent entity at the other end (pure NTG).…”

Section: Or Many Years It Has Beenmentioning

confidence: 99%

Primary Open-Angle Glaucoma vs Normal-Tension Glaucoma

et al. 2013

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“…Virtually, all organs, particularly the eye, can be involved. Retinal vessels were stiffer both in patients with glaucoma [218] and in those with PVD [219] and were more irregular [220] in PVD subjects. The vascular response to flicker light was reduced both in patients with glaucoma [174] and with PVD [168, 169] (Fig.…”

Section: From Vasospasm To Vascular Dysregulationmentioning

confidence: 99%

The discovery of the Flammer syndrome: a historical and personal perspective

Flammer

Konieczka

2017

EPMA Journal

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This review describes the clinical and basic research that led to the description of Flammer syndrome. It is narrated from a personal perspective. This research was initiated by the observation of an increased long-term fluctuation of visual fields in a subgroup of glaucoma patients. As these patients had strikingly cold hands, peripheral blood flow was tested with a capillary microscopy, and vasospastic syndrome (VS) was diagnosed. Further studies on these patients revealed frequently weakened autoregulation of ocular blood flow and increased flow resistivity in retroocular vessels. Their retinal vessels were more rigid and irregular and responded less to flickering light. Holistic investigation demonstrated low blood pressure, silent myocardial ischaemia, altered beat-to-beat variation, altered gene expression in the lymphocytes, slightly increased plasma endothelin level and increased systemic oxidative stress. This combination of signs and symptoms was better described by the term primary vascular dysregulation (PVD) than by VS. Subsequent studies showed additional symptoms frequently related to PVD, such as low body mass index, cold extremities combined with slightly increased core temperature, prolonged sleep onset time, reduced feelings of thirst, increased sensitivity to smell and also for certain drugs and increased retinal venous pressure. To better characterise this entire syndrome, the term Flammer syndrome (FS) was introduced. Most subjects with FS were healthy. Nevertheless, FS seemed to increase the risk for certain eye diseases, particularly in younger patients. This included normal-tension glaucoma, anterior ischaemic optic neuropathy, retinal vein occlusions, Susac syndrome and central serous chorioretinopathy. Hereditary diseases, such as Leber’s optic neuropathy or retinitis pigmentosa, were also associated with FS, and FS symptoms and sings occurred more frequent in patients with multiple sclerosis or with acute hearing loss. Further research should lead to a more concise definition of FS, a precise diagnosis and tools for recognizing people at risk for associated diseases. This may ultimately lead to more efficient and more personalised treatment.

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Rigidity of Retinal Vessel in Untreated Eyes of Normal Tension Primary Open-angle Glaucoma Patients

Abstract: Untreated NTG eyes show stiffer retinal vessels. Vessel rigidity correlates with level of glaucomatous damage.

Cited by 31 publications

References 23 publications

Intraocular pressure correlates with optic nerve sheath diameter in patients with normal tension glaucoma

Intraocular pressure correlates with optic nerve sheath diameter in patients with normal tension glaucoma

Primary Open-Angle Glaucoma vs Normal-Tension Glaucoma

The discovery of the Flammer syndrome: a historical and personal perspective

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