Fuchsjäger-Mayrl Gabriele, Wally Beate, Georgopoulos Michael, Rainer Georg, Kircher Karl, Buehl Wolf, Amoako-Mensah Tina, Eichler Hans-Georg, Vass Clemens, Schmetterer Leopold
Departments of Clinical Pharmacology and. Ophthalmology, and the. Institute of Medical Physics, University of Vienna, Vienna, Austria.
Invest Ophthalmol Vis Sci. 2004 Mar;45(3):834-9. doi: 10.1167/iovs.03-0461.
There is evidence that altered optic nerve head (ONH) blood flow may play a role in the development and progression of glaucoma. In the present study, the baseline characteristics were examined in a study population participating in a clinical trial in which the ocular hemodynamic effects of timolol and dorzolamide were compared.
One hundred forty patients with primary open-angle glaucoma (POAG) or ocular hypertension (OHT) were included in this trial and their baseline parameters compared with those of a group of 102 age-matched control subjects. Scanning laser Doppler flowmetry was used to measure blood flow in the temporal neuroretinal rim and the cup of the ONH. Pulsatile choroidal blood flow was assessed by laser interferometric measurement of fundus pulsation amplitude. In addition, hemodynamic parameters and mean arterial pressure were calculated in both groups.
All ocular hemodynamic parameters were significantly lower in the POAG/OHT group compared with the healthy control group (P < 0.001 each). In addition, a significant positive correlation between laser Doppler flowmetry readings and mean arterial pressure was observed in patients with glaucoma but not in healthy control subjects. Likewise, the correlation coefficient between fundus pulsation amplitude and mean arterial pressure was higher in patients with glaucoma than in healthy control subjects.
The present study indicates reduced ONH and choroidal blood flow and an abnormal association between blood pressure and ocular perfusion in patients with primary open-angle glaucoma or ocular hypertension, independent of topical antiglaucoma medication. Hence, vascular dysregulation appears to be an early manifestation in glaucoma that is not caused by pharmacologic intervention.
有证据表明，视神经乳头（ONH）血流改变可能在青光眼的发生和发展中起作用。在本研究中，对参与一项比较噻吗洛尔和多佐胺眼血流动力学效应的临床试验的研究人群的基线特征进行了检查。
140例原发性开角型青光眼（POAG）或高眼压症（OHT）患者纳入本试验，并将其基线参数与102名年龄匹配的对照受试者的参数进行比较。使用扫描激光多普勒血流仪测量颞侧神经视网膜边缘和ONH杯的血流。通过激光干涉测量眼底搏动幅度来评估脉络膜搏动血流。此外，计算两组的血流动力学参数和平均动脉压。
与健康对照组相比，POAG/OHT组的所有眼血流动力学参数均显著降低（每组P < 0.001）。此外，在青光眼患者中观察到激光多普勒血流仪读数与平均动脉压之间存在显著正相关，而在健康对照受试者中未观察到。同样，青光眼患者眼底搏动幅度与平均动脉压之间的相关系数高于健康对照受试者。
本研究表明，原发性开角型青光眼或高眼压症患者的ONH和脉络膜血流减少，血压与眼灌注之间存在异常关联，且与局部抗青光眼药物无关。因此，血管调节异常似乎是青光眼的一种早期表现，并非由药物干预引起。
