Literature review and meta-analysis of translaminar pressure difference in open-angle glaucoma

Abstract

There is increasing evidence in the literature regarding translaminar pressure difference's (TPD) role in the pathophysiology of glaucoma. The optic nerve is exposed not only to intraocular pressure in the eye, but also to intracranial pressure (ICP), as it is surrounded by cerebrospinal fluid in the subarachnoid space. Although pilot studies have identified the potential importance of TPD in glaucoma, limited available data currently prevent a comprehensive description of the role that TPD may have in glaucomatous pathophysiology. In this review, we present all available qualified data from a systematic review of the literature of the role of TPD in open-angle glaucoma (OAG). PubMed (Medline), OVID Medline, ScienceDirect, SpringerLink, and all available library databases were reviewed and subsequent meta-analysis of pooled mean differences are presented where appropriate. Five papers including 396 patients met criteria for inclusion to the analysis. Importantly, we included all observational studies despite differences in ICP measurement methods, as there is no consensus regarding best-practice ICP measurements in glaucoma. Our results show that not only TPD is higher in glaucoma patients compared with healthy subjects, it is related to structural glaucomatous changes of the optic disc. Our analysis suggests further longitudinal prospective studies are needed to investigate the influence of TPD in OAG, with a goal of overcoming methodological weaknesses of previous studies.

Estimated Cerebrospina Fluid Pressure and the 5-Year Incidence of Primary Open-Angle Glaucoma in a Chinese Population

“…[19] However, this cross-sectional association is not supported by the current longitudinal analysis in our study. Using the YMES 5-year follow-up data, we did not find any significant association or trend between the baseline estimated CSFP and the incidence of POAG.…”

Glaucoma: the retina and beyond

“…This hypothesis may also explain the increased incidence of glaucoma in patients with a history of migraine (Table 1), as elevated intracranial pressure is associated with this condition [164]. A recent literature review and meta-analysis comprising five papers and a total of 396 patients by Siaudvytyte et al revealed that CSFP is elevated in glaucoma patients compared to healthy subjects and TLPD is related to changes in optic disc structure in patients with high-tension glaucoma [162]. The authors caution, however, that further experimental investigations and longitudinal prospective clinical studies are required to overcome the methodological weaknesses of the current studies, concerns echoed by Pircher and Killer [138].…”

Update on the Prevalence, Etiology, Diagnosis, and Monitoring of Normal-Tension Glaucoma

“…73 Studies have also reported that intracranial pressure is lower in patients with NTG than in those with POAG or normal subjects. 72,[74][75][76] Low intracranial pressure in the context of normal IOP levels might in fact lead to an abnormally large translaminar cribrosa pressure difference, thereby increasing the probability of glaucomatous damage. Jonas et al, 41 utilizing data from the Beijing Eye Study, reported that translaminar pressure difference (calculated with body mass index, diastolic blood pressure, and age) showed a better correlation with the extent of glaucomatous damage than did IOP, indicating its potential role as a biomarker for open-angle glaucoma.…”