Stodtmeister Richard, Koch Wiebke, Georgii Sylvana, Pillunat Karin R, Spörl Eberhard, Pillunat Lutz E
Augenklinik, Technische Universität Dresden, Dresden, Germany.
Augenarzt, Augenspezialisten Saar, Völklingen, Germany.
Klin Monbl Augenheilkd. 2022 Mar;239(3):319-325. doi: 10.1055/a-1318-9991. Epub 2021 Jan 12.
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.
Study type: cross-sectional.
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.
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), -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 -blocker group. Here, the 17 patients with systemic -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 -blocker. The median IOP was 15.7 mmHg with systemic -blockers and 16.1 mmHg without (p = 0.85).
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 -blockers, in which the RVP was lower by 4.6 mmHg than for the patients who did not receive these drugs (p = 0.003).
到目前为止，眼内静脉压一直被广泛等同于眼压（IOP）。使用以仪器单位或力校准的测力计进行的测量表明，青光眼患者的视网膜静脉压（RVP）可能高于眼压。在本研究中，使用以毫米汞柱校准的隐形眼镜测力计测量RVP。
研究类型：横断面研究。
50例连续接受药物治疗下昼夜眼压曲线测量的原发性开角型青光眼（POAG）患者。年龄：69±8岁。RVP测量：隐形眼镜测力法。眼压测量：动态轮廓眼压测量法。
压力以毫米汞柱为单位给出。在所有50例患者中，眼压为15.9（13.6；17.1）[中位数（Q1；Q3）]，RVP为17.4（14.8；27.2）。眼压分布呈正态分布，RVP分布呈右偏态。在34例视网膜中央静脉自发搏动（SVP）的患者亚组中，眼压以及根据定义的RVP为16.5（13.7；17.4）。在16例无SVP的患者亚组中，眼压为14.8（13.3；16.4），RVP为31.3（26.2；38.8）（p≤0.001）。在全身治疗中，使用的药物有（括号内为患者数量）：ACE抑制剂（20例）、β受体阻滞剂（17例）、血管紧张素II受体阻滞剂（13例）、钙通道阻滞剂（12例）、利尿剂（7例）。接受这些药物和未接受这些药物的患者之间，除β受体阻滞剂组外，RVP未观察到差异。在此组中，17例接受全身β受体阻滞剂治疗的患者RVP中位数为15.6毫米汞柱，未接受治疗的患者为20.2毫米汞柱（p = 0.003）。在16例RVP高于眼压的患者中，只有1例接受全身β受体阻滞剂治疗。接受全身β受体阻滞剂治疗的患者眼压中位数为15.7毫米汞柱，未接受治疗的患者为16.1毫米汞柱（p = 0.85）。
在研究的50例患者中的16例亚组中，RVP比眼压高，具有高度统计学和临床意义。根据关于视网膜和视神经乳头循环病理生理学的广泛接受的观点，在这组患者中，这些组织中的血流可能比之前假设的受到更大损害。他们可能通过缺乏SVP来识别。局部和全身药物对RVP无统计学显著影响，但全身β受体阻滞剂除外，其中RVP比未接受这些药物的患者低4.6毫米汞柱（p = 0.003）。
