Cerebrospinal Fluid Pressure in Glaucoma

Ren, Ruojin; Jonas, Jost B.; Tian, Guoghong; Zhen, Yi; Ma, Ke; Li, Shuning; Wang, Hongtao; Li, Bin; Zhang, Xiaojun; Wang, Ke

doi:10.1016/j.ophtha.2009.06.058

Cited by 468 publications

(474 citation statements)

References 34 publications

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“…Nevertheless, existing data suggests that possibly in these patients, orbital ICP may not exactly reflect the supine, lumbar-measured ICP. Data from direct contrast-injection into the subarachnoid space of glaucoma patients have proven that CSF fluid dynamics are disturbed in the retrobulbar part of the optic nerve sheath [20].…”

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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“…38 As the arterial circle is the main arterial source for the lamina cribrosa blood supply, 39,40 it has been discussed whether the high axial myopia induced increased distance between the arterial circle, and the lamina cribrosa may be of importance for the pathogenesis of an increased glaucoma susceptibility in highly myopic eyes.…”

Section: Optic Nerve Headmentioning

confidence: 99%

Histological changes of high axial myopia

Jonas

2013

Eye

132

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To describe pathological changes in the anatomy of highly myopic (axially elongated) eyes, enucleated globes were examined by light microscopy and ocular structures were measured histomorphometrically. These studies revealed that highly axially myopic eyes show continuous thinning of the sclera starting at or behind the equator with a maximal thinning at the posterior pole; a profound thinning of the choroid decreasing from B250 to o10 mm in extreme axial myopia, secondary macular defects in the Bruch's membrane associated with a complete loss of retinal pigment epithelium and choriocapillaris, and retinal photoreceptors; a Bruch's membrane of normal thickness in contrast to the profound thinning of the choroid and the sclera; an up to 10-fold elongation and thinning of the peripapillary scleral flange as anterior roof of the orbital cerebrospinal fluid space, and subsequently a retrobulbar extension of the cerebrospinal fluid space; an increased distance of the peripapillary arterial circle of Zinn-Haller to the optic disc border; an elongation and thinning of the lamina cribrosa with a subsequently decreased distance between the intraocular pressure compartment and the retrobulbar orbital cerebrospinal fluid pressure compartment; an increasing exposure of the peripheral posterior lamina cribrosa surface to the cerebrospinal fluid space, no longer buffered by the solid optic nerve tissue; and the development and enlargement of parapapillary gamma zone, in contrast to a myopia-independent parapapillary beta zone. These anatomical changes may be associated with high axial myopia-related complications such as an increased susceptibility of glaucomatous optic neuropathy and myopic retinopathy.

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“…Traditionally, IOP is thought to primarily influence the optic nerve and that IOP elevation is the key issue in glaucoma. However, Berdahl et al suggested that ICP might also be a critical factor for determining pressure on the optic nerve (Berdahl et al, 2008a, b;Ren et al, 2010). This theory is compatible with the experimental observation that lowering cerebrospinal fluid (CSF) pressure over the course of one year, via CSF shunting from the lumbar cistern to the abdomen, can lead to optic nerve damage in monkeys (Yang et al, 2014).…”

Section: Introductionmentioning

confidence: 73%

Pressure balance and imbalance in the optic nerve chamber: The Beijing Intracranial and Intraocular Pressure (iCOP) Study

Hou

Zheng

Yang

et al. 2016

Sci. China Life Sci.

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To determine the interdependence of intracranial pressure (ICP) and intraocular pressure (IOP) and how it affects optic nerve pressures, eight normal dogs were examined using pressure-sensing probes implanted into the left ventricle, lumbar cistern, optic nerve subarachnoid space in the left eye, and anterior chamber in the left eye. This allowed ICP, lumbar cistern pressure (LCP), optic nerve subarachnoid space pressure (ONSP) and IOP to be simultaneously recorded. After establishing baseline pressure levels, pressure changes that resulted from lowering ICP (via shunting cerebrospinal fluid (CSF) from the ventricle) were recorded. At baseline, all examined pressures were different (ICP>LCP>ONSP), but correlated (P<0.001). As ICP was lowered during CSF shunting, IOP also dropped in a parallel time course so that the trans-lamina cribrosa gradient (TLPG) remained stable (ICP-IOP dependent zone). However, once ICP fell below a critical breakpoint, ICP and IOP became uncoupled and TLPG changed as ICP declined (ICP-IOP independent zone). The optic nerve pressure gradient (ONPG) and trans-optic nerve pressure gradient (TOPG) increased linearly as ICP decreased through both the ICP-IOP dependent and independent zones. We conclude that ICP and IOP are coupled in a specific pressure range, but when ICP drops below a critical point, IOP and ICP become uncoupled and TLPG increases. When ICP drops, a rise in the ONPG and TOPG creates more pressure and reduces CSF flow around the optic nerve. This change may play a role in the development and progression of various ophthalmic and neurological diseases, including glaucoma. glaucoma, optic neuropathy, trans-lamina cribrosa pressure gradient (TLPG), trans-optic canal pressure gradient (TCPG), trans-optic nerve pressure gradient (TOPG), optic nerve pressure gradient (ONPG) Citation:

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Cerebrospinal Fluid Pressure in Glaucoma

Cited by 468 publications

References 34 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

Histological changes of high axial myopia

Pressure balance and imbalance in the optic nerve chamber: The Beijing Intracranial and Intraocular Pressure (iCOP) Study

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