Abstract:
INTRODUCTION:Until now, venous pressure within the eye has widely been equated with intraocular pressure (IOP). Measurements with dynamometers calibrated in instrument units or in force showed that the retinal venous pressure (RVP) may be higher than the IOP in glaucoma patients. In this study, the RVP was measured with a contact lens dynamometer calibrated in mmHg. METHODS:Study type: cross-sectional. SUBJECTS:Fifty consecutive patients with primary open-angle glaucoma (POAG) who underwent diurnal curve measurement under medication. Age: 69 ± 8 years. Measurement of RVP: contact lens dynamometry. IOP measurement: dynamic contour tonometry. RESULTS:Pressures are given in mmHg. In all 50 patients, the IOP was 15.9 (13.6; 17.1) [median (Q1; Q3)], and the RVP was 17.4 (14.8; 27.2). The distribution of the IOP was normal and that of the RVP was right skewed. In the subgroup of 34 patients with spontaneous pulsation of the central retinal vein (SVP), the IOP and therefore, by definition, the RVP was 16.5 (13.7; 17.4). In the subgroup of 16 patients without SVP, the IOP was 14.8 (13.3; 16.4), and the RVP was 31.3 (26.2; 38.8) (p ≤ 0.001). In systemic treatment, the prescribed drugs were (the number of patients is given in parentheses): ACE inhibitors (20), β-blockers (17), angiotensin II-receptor blockers (13), calcium channel blockers (12), diuretics (7). No difference in RVP was observed between patients receiving these drugs and not receiving them, except in the β-blocker group. Here, the 17 patients with systemic β-blockers had a median RVP of 15.6 mmHg and without 20.2 mmHg (p = 0.003). In the 16 patients with a higher RVP than IOP, only one patient received a systemic β-blocker. The median IOP was 15.7 mmHg with systemic β-blockers and 16.1 mmHg without (p = 0.85). CONCLUSION:In a subgroup of 16 of the 50 patients studied, the RVP was greater than the IOP by a highly statistically and clinically significant degree. According to the widely accepted thinking on the pathophysiology of retinal and optic nerve head circulation, the blood flow in these tissues may be much more compromised in this group of patients than has been assumed. They may be identified by a missing SVP. Topical and systemic medications showed no statistically significant influence on the RVP, except for the systemic β-blockers, in which the RVP was lower by 4.6 mmHg than for the patients who did not receive these drugs (p = 0.003). HINTERGRUND:Bis heute wird der venöse Druck im Auge weithin dem intraokularen Druck (IOP) gleichgesetzt. Messungen mit Dynamometern, die in Geräteeinheiten oder Kraft kalibriert waren, zeigten, dass der retinale Venendruck (RVP) bei Glaukompatienten höher sein kann als der IOP. In der hier vorgestellten Studie wurde der RVP mit einem Kontaktglasdynamometer (KGD) gemessen, das in mmHg kalibriert war. METHODEN:Studientyp: Querschnittstudie. Untersuchte Personen: 50 Patienten mit primärem Offenwinkelglaukom, bei denen ein Tagesdruckprofil unter Medikation erstellt wurde. Das durchschnittliche Alter war 69 ± 8 Jahre. Messung des IOP: dynamisches Konturtonometer. ERGEBNISSE:Druckwerte in mmHg. Bei allen 50 Patienten war der IOP 15,9 (13,6; 17,1) (Median, Q1; Q3) und der RVP 17,4 (14,8; 27,2). Die Verteilung des IOP war normal und die Verteilung des RVP war linksgipflig. In der Untergruppe mit 34 Patienten, die eine spontane Pulsation der Zentralvene aufwiesen, war der IOP und somit definitionsgemäß der RVP 16,5 (13,7; 17,4). In der Untergruppe mit 16 Patienten, die keine spontane Pulsation der Zentralvene aufwiesen, war der IOP 14,8 (13,3; 16,4) und der retinale Venendruck 31,3 (26,2; 38,8) (p ≤ 0,001). Bei den 17 der 50 Patienten, die systemische β-Blocker erhielten, war der mediane RVP 15,6 mmHg, bei den 33 Patienten ohne diese Medikamente war er 20,2 mmHg (p = 0,003). Bei den 16 Patienten, bei denen der RVP höher war als der IOP, war nur 1 Patient, der einen systemischen β-Blocker erhielt. Der IOP zeigte keinen Unterschied (p = 0,85). SCHLUSSFOLGERUNG:In der Untergruppe mit 16 der 50 untersuchten Patienten war der retinale Venendruck statistisch und klinisch signifikant höher als der IOP. Entsprechend der weithin akzeptierten Ansicht in der Pathophysiologie der retinalen Durchblutung und der Durchblutung des Sehnervenkopfes war somit in dieser Patientengruppe der Blutfluss deutlich mehr beeinträchtigt als bisher angenommen. Diese Patienten können an der fehlenden spontanen Pulsation der Zentralvene erkannt werden. Örtlich und systemisch applizierte Medikamente zeigten keinen statistisch signifikanten Einfluss auf den RVP mit Ausnahme der systemischen β-Blocker, unter deren Therapie der RVP um 4,6 mmHg niedriger war als bei den Patienten, die diese Medikamente nicht erhielten (p = 0,003).
journal_name
Klin Monbl Augenheilkdjournal_title
Klinische Monatsblatter fur Augenheilkundeauthors
Stodtmeister R,Koch W,Georgii S,Pillunat KR,Spörl E,Pillunat LEdoi
10.1055/a-1318-9991subject
Has Abstractpub_date
2021-01-12 00:00:00eissn
0023-2165issn
1439-3999pub_type
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