Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China.
Acta Ophthalmol. 2014 Sep;92(6):e475-80. doi: 10.1111/aos.12263. Epub 2013 Sep 11.
To assess whether a Valsalva manoeuver influences intra-ocular pressure (IOP), cerebrospinal fluid pressure (CSF-P) and, by a change in the trans-laminar cribrosa pressure difference, optic nerve head morphology.
In the first part of the study, 20 neurological patients (study group 'A') underwent measurement of IOP and lumbar CSF-P measurement in a lying position before and during a Valsalva manoeuver. In the second study part, 20 healthy subjects (study group 'B') underwent ocular tonometry and confocal scanning laser tomography of the optic nerve head before and during a Valsalva manoeuver.
During the Valsalva manoeuver in study group 'A', the increase in CSF-P by 10.5 ± 2.7 mmHg was significantly (p < 0.001) higher than the increase in IOP by 1.9 ± 2.4 mmHg. The change in CSF-P was not significantly (p = 0.61) correlated with the change in IOP. During the Valsalva manoeuver in study group 'B', IOP increased by 4.5 ± 4.2 mmHg and optic cup volume (p < 0.001), cup/disc area ratio (p = 0.02), cup/disc diameter ratio (p = 0.03) and maximum optic cup depth (p = 0.01) significantly decreased, while neuroretinal rim volume (p = 0.005) and mean retinal nerve fibre layer thickness (p = 0.02) significantly increased.
The Valsalva manoeuver-associated short-term increase in CSF-P was significantly larger than a simultaneous short-term increase in IOP. It led to a Valsalva manoeuver-associated decrease or reversal of the trans-laminar cribrosa pressure difference, which was associated with a change in the three-dimensional optic nerve head morphology: optic cup-related parameters decreased and neuroretinal rim-related parameters enlarged. These findings may be of interest for the pathogenesis of glaucomatous optic neuropathy.
评估瓦氏动作是否会影响眼内压（IOP）、脑脊液压力（CSF-P），并通过改变颅脊蛛网膜压力差来影响视神经头形态。
在研究的第一部分中，20 名神经科患者（研究组 A）在仰卧位时测量了 IOP 和腰椎 CSF-P，然后在进行瓦氏动作时再次测量。在第二部分研究中，20 名健康受试者（研究组 B）在进行瓦氏动作前和进行瓦氏动作时进行了眼部眼压测量和视神经头共焦激光扫描断层成像。
在研究组 A 进行瓦氏动作期间，CSF-P 增加 10.5±2.7mmHg，明显高于 IOP 增加 1.9±2.4mmHg（p<0.001）。CSF-P 的变化与 IOP 的变化无明显相关性（p=0.61）。在研究组 B 进行瓦氏动作期间，IOP 增加 4.5±4.2mmHg，杯盘面积比（p<0.001）、杯盘直径比（p=0.03）和最大杯盘深度（p=0.01）明显减小，而神经视网膜边缘体积（p=0.005）和平均视网膜神经纤维层厚度（p=0.02）明显增加。
瓦氏动作相关的 CSF-P 短期增加明显大于同时发生的 IOP 短期增加。它导致了颅脊蛛网膜压力差的瓦氏动作相关的减小或逆转，这与视神经头三维形态的变化有关：与杯相关的参数减小，与神经视网膜边缘相关的参数增大。这些发现可能与青光眼视神经病变的发病机制有关。
