Ulrich W-D, Moeller A, Ulrich C, Siebert G, Wernecke K-D, Erb C
Augenarztpraxis, 04552 Borna.
Sostana GmbH, 10117 Berlin.
Klin Monbl Augenheilkd. 2015 Feb;232(2):152-61. doi: 10.1055/s-0034-1396210. Epub 2015 Feb 20.
The results of studies of ocular blood flow (BF) regulation of patients with primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG) and ocular hypertension (OH) are presented.
Examinations were carried out with the "OPFA", a newly developed ocular pressure flow analyzer (producer: tpm Lüneburg) on 92 patients with newly diagnosed glaucomas, among whom 48 patients had POAG, 22 NTG and 22 OH, and compared with age-matched groups of healthy subjects. The OPFA uses pneumatic coupling through special scleral suction cups to record ocular pulses with highly sensitive transducers and a suction pump for simultaneously increasing intraocular pressure (IOP). Following local drop anaesthesia on both eyes, IOP is artificially raised to suprasystolic values. While continuously lowering IOP, the ocular pulse is then recorded with increasing ocular perfusion pressure. We obtain the relative ocular pulse blood volume by correlating the ocular pulse amplitudes with a calibration volume of 1 µl. This enables us to collect reproducible data on intra- and inter-individual pulse blood volume (PVoc). The ocular perfusion pressure pulse blood volume curve characterizes the respective individual ocular circulation as well as systolic and diastolic ocular perfusion pressures.
In healthy subjects, the ocular pulse blood volume remains stable over a certain range of ocular perfusion pressure (ppoc) changes. After exceeding a critical point (CP), the ocular pulse blood volume drops. We refer to the difference between the CP and IOP as the autoregulatory capacity (AC). In patients with POAG and in patients with NTG, the AC was reduced significantly compared with the groups of healthy subjects. The mean AC of patients with OH remained within the normal range. The ROC curves showed at an optimal cut-off value for POAG a sensitivity of 75.0 % and a specificity of 97.9 %, for NTG a sensitivity of 77.3 % and a specificity of 100 %. In patients with POAG and OH, the ocular arterial pressures were elevated. In patients with NTG they remained unchanged compared with the healthy subjects. The ocular perfusion pressures did not change in POAG as well as in NTG and OH.
In patients with POAG and in patients with NTG the ocular BF regulation was impaired and detected by the OPFA device with a high level of reliability. Ocular arterial blood pressures were increased as a result of vascular regulation to keep up the ocular perfusion pressure and to maintain ocular perfusion.
本文展示了对原发性开角型青光眼（POAG）、正常眼压性青光眼（NTG）和高眼压症（OH）患者眼血流（BF）调节的研究结果。
使用新开发的眼压血流分析仪“OPFA”（生产商：tpm吕讷堡）对92例新诊断的青光眼患者进行检查，其中48例为POAG患者，22例为NTG患者，22例为OH患者，并与年龄匹配的健康受试者组进行比较。OPFA通过特殊的巩膜吸盘采用气动耦合，用高灵敏度传感器和一个用于同时升高眼压（IOP）的真空泵记录眼脉搏。在双眼局部滴用麻醉剂后，将眼压人为升高至收缩压以上的值。在持续降低眼压的同时，随着眼灌注压升高记录眼脉搏。通过将眼脉搏振幅与1µl的校准体积相关联，我们获得相对眼脉搏血容量。这使我们能够收集关于个体内和个体间脉搏血容量（PVoc）的可重复数据。眼灌注压脉搏血容量曲线表征了各个个体的眼循环以及收缩期和舒张期眼灌注压。
在健康受试者中，眼脉搏血容量在一定范围的眼灌注压（ppoc）变化内保持稳定。超过临界点（CP）后，眼脉搏血容量下降。我们将CP与IOP之间的差值称为自动调节能力（AC）。与健康受试者组相比，POAG患者和NTG患者的AC显著降低。OH患者的平均AC保持在正常范围内。ROC曲线显示，对于POAG，在最佳临界值时灵敏度为75.0%，特异性为97.9%；对于NTG，灵敏度为77.3%，特异性为100%。POAG和OH患者的眼动脉压升高。与健康受试者相比，NTG患者的眼动脉压保持不变。POAG、NTG和OH患者的眼灌注压均未改变。
POAG患者和NTG患者的眼BF调节受损，且OPFA设备能高度可靠地检测到这一点。由于血管调节，眼动脉血压升高以维持眼灌注压和眼灌注。
