Unexpected Effect of Calcium Channel Blockers on the Optic Nerve Compartment Syndrome

Konieczka, Katarzyna; Todorova, Margarita G.; Bojinova, R. I.; Binggeli, Tatjana; Chackathayil, T. N.

doi:10.1055/s-0042-102619

Cited by 16 publications

(18 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The involvement of FS has already been described for the following diseases: retinitis pigmentosa [11, 41–43], Leber’s hereditary optic neuropathy [44], optic nerve compartment syndrome [45, 46], retinal vein occlusions [11, 47, 48], cilioretinal artery occlusion [49], choroidal infarction [50], Susac syndrome [11], anterior ischemic optic neuropathy [11], central serous chorioretinopathy, [11], multiple sclerosis [34], and perioperative visual loss during general anesthesia [51, 52]. The relationship between FS and breast cancer has already been suggested [53] and some first results are presented in this issue of this journal.…”

Section: Discussionmentioning

confidence: 99%

Relationship between normal tension glaucoma and Flammer syndrome

et al. 2017

View full text Add to dashboard Cite

BackgroundBesides intraocular pressure, vascular factors play a role in the pathogenesis of glaucomatous optic neuropathy. One of these potential vascular factors is Flammer syndrome. The purpose of the present study was to determine in a Korean population whether signs and symptoms of Flammer syndrome occur more often in normal tension glaucoma patients than in control subjects.MethodsTwo hundred forty-six normal tension glaucoma patients and 1116 control subjects responded to a multiple-choice questionnaire asking about 15 signs and symptoms of Flammer syndrome.ResultsSeven of the 15 signs and symptoms of Flammer syndrome (increased drug sensitivity, good smell perception, reversible skin blotches, tinnitus, long sleep onset time, tendency to perfectionism, and cold hands/feet) were significantly more often positive in normal tension glaucoma patients than in controls. Six additional signs and symptoms (migraines, low blood pressure, headaches, dizziness, increased pain sensation, and feeling cold) also occurred more often, but did not reach statistical significance. Only two items (low body weight and reduced feeling of thirst) were more frequently (not significant) positive in the controls.ConclusionThere is an association between normal tension glaucoma and Flammer syndrome. If future studies confirm this relationship, treatment of Flammer syndrome may help to prevent normal tension glaucoma or to slow down its progression.

show abstract

Section: Discussionmentioning

confidence: 99%

Relationship between normal tension glaucoma and Flammer syndrome

et al. 2017

View full text Add to dashboard Cite

show abstract

“…This leads to differences of fluid composition, reduced CSF exchange and an extension of the optic nerve sheath diameter due to increased pressure [222, 264–274]. We observed that ONCS was often related to PVD [2] and that treatment of FS with a low dose of CCBs also reduced ONCS [275]. …”

Section: Choroidal Infarctionmentioning

confidence: 99%

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

Flammer

Konieczka

2017

EPMA Journal

View full text Add to dashboard Cite

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.

show abstract

“…On the occasion of the last consultation (2016) for this patient, we conducted two additional examinations not available in our clinic previously, namely: measurement of the RVP [5] and eye socket echography, searching for ONCS [6]. While the RVP is equal to or slightly higher than the IOP in healthy subjects, it is often increased in patients with ophthalmic and systemic diseases [5], such as NTG.…”

Section: Case Presentationmentioning

confidence: 99%

“…This leads to the extension of the optic nerve sheath diameter and an altered chemical composition of the cerebrospinal fluid. ONCS has often been demonstrated in patients with NTG [4], particularly in the presence of FS [6]. However, the pathogenesis of ONCS has not yet become totally clear.…”

Section: Case Presentationmentioning

confidence: 99%