Department of Ophthalmology, Medical Faculty Carl Gustav Carus, Technische Universität, Dresden, Germany.
Br J Ophthalmol. 2014 Oct;98(10):1374-8. doi: 10.1136/bjophthalmol-2014-305126. Epub 2014 May 12.
To evaluate the central retinal venous pulsation pressure (CRVPP) in patients with intraocular pressure (IOP)-controlled early, moderate and advanced open-angle glaucoma and a healthy control group.
CRVPP was measured with a contact lens dynamometer calibrated in mm Hg (Meditron GmbH, Voelklingen, Germany) in 34 patients with IOP-controlled open-angle glaucoma who were selected consecutively and according to the stage of their visual fields and 27 age-matched healthy controls. If a spontaneous venous pulsation was seen, CRVPP was considered to be equal to IOP. Visual fields were tested with the Humphrey 30-2 SST programme. The ocular perfusion pressure was conventionally calculated as OPP1=2/3MAP - IOP (MAP=systemic mean arterial blood pressure) and, using the measured CRVPP in the formula, as OPP2=2/3MAP - CRVPP. Statistical analysis was performed using the Kruskal-Wallis and the Mann-Whitney U test.
Median CRVPP was 14.0 mm Hg (IQR 12.0-16.0) in controls, 15.0 mm Hg (IQR 14.0-17.0) in early, 38.9 mm Hg (IQR 29.9-48.4) in moderate and 34.6 mm Hg (IQR 23.9-51.0) in advanced glaucoma cases. The conventionally calculated OPP1 was 49.8 mm Hg (IQR 42.7-57.6) for controls, 56.9 mm Hg (IQR 55.3-58.8) for early, 56.6 mm Hg (IQR 51.2-64.4) for moderate and 59.3 mm Hg (IQR 53.9-61.6) for advanced cases. OPP2 was equal to OPP1 in the control group, 56.1 mm Hg (IQR 54.5-57.9) in early, 25.1 mm Hg (IQR 15.7-38.6) and 34.2 mm Hg (IQR 20.4-47.5) in moderate and advanced cases. This difference was statistically significant for moderate (OPP2 lower; p=0.003) and advanced (OPP2 lower; p=0.002) cases.
In more advanced cases of glaucoma, CRVPP seems to be much higher than previously thought. This might further compromise the perfusion pressure in the prelaminar region of the optic nerve head and be of clinical importance, especially in IOP-controlled more advanced cases. This should be considered as a possible risk factor for progression.
ClinicalTrials.gov ID: NCT01503996.
评估眼压（IOP）控制的早期、中度和晚期开角型青光眼患者以及健康对照组的中央视网膜静脉搏动压（CRVPP）。
使用 Meditron GmbH（德国 Voelklingen）生产的校准为毫米汞柱（mmHg）的接触式眼压计（接触镜眼压计）对 34 名连续选择的 IOP 控制的开角型青光眼患者和 27 名年龄匹配的健康对照组进行 CRVPP 测量。如果出现自发性静脉搏动，则认为 CRVPP 等于 IOP。视野采用 Humphrey 30-2 SST 程序进行测试。眼内灌注压通常按公式 OPP1=2/3MAP-IOP（MAP=全身平均动脉血压）计算，也可按测量的 CRVPP 按公式 OPP2=2/3MAP-CRVPP 计算。采用 Kruskal-Wallis 和 Mann-Whitney U 检验进行统计学分析。
对照组的中位 CRVPP 为 14.0mmHg（IQR 12.0-16.0），早期为 15.0mmHg（IQR 14.0-17.0），中度为 38.9mmHg（IQR 29.9-48.4），晚期为 34.6mmHg（IQR 23.9-51.0）。对照组的传统计算的 OPP1 为 49.8mmHg（IQR 42.7-57.6），早期为 56.9mmHg（IQR 55.3-58.8），中度为 56.6mmHg（IQR 51.2-64.4），晚期为 59.3mmHg（IQR 53.9-61.6）。对照组的 OPP2 等于 OPP1，早期为 56.1mmHg（IQR 54.5-57.9），中度为 25.1mmHg（IQR 15.7-38.6）和 34.2mmHg（IQR 20.4-47.5），晚期为 34.2mmHg（IQR 20.4-47.5）。中度（OPP2 较低；p=0.003）和晚期（OPP2 较低；p=0.002）病例的差异具有统计学意义。
在更晚期的青光眼病例中，CRVPP 似乎比以前认为的要高得多。这可能会进一步损害视乳头前层区域的灌注压，并具有临床重要性，特别是在 IOP 控制的更晚期病例中。这应被视为进展的一个可能的危险因素。
ClinicalTrials.gov 标识符：NCT01503996。
