Grunwald J E, DuPont J, Dreyer E B
Department of Ophthalmology, Scheie Eye Institute, School of Medicine, University of Pennsylvania, Philadelphia 19104, USA.
Am J Ophthalmol. 1997 Jun;123(6):753-8. doi: 10.1016/s0002-9394(14)71123-7.
A recent report has suggested that nitrate therapy may delay the progression of glaucomatous damage. To investigate the mechanism that may mediate this effect, we sought to determine whether nitrate therapy is associated with retinal vasodilatation in patients with glaucoma.
Retinal venous and arterial diameters were determined from color fundus photographs of the optic nerve head obtained during a retrospective study designed to investigate any potential effects of chronic nitrate treatment on the progression of glaucomatous pathology. Fourteen eyes of 14 patients who were receiving chronic nitrate therapy for systemic diseases unrelated to glaucoma were randomly selected. Vascular measurements were compared with those of 15 eyes of 15 control patients with glaucoma who did not receive any nitrate therapy.
In comparison with control patients, nitrate-treated patients showed significant average vasodilatation of 17% (P = .008) and 13% (P = .01) in the superior and inferior temporal retinal veins, respectively. A 5% increase in average retinal arterial diameter was also detected, but this was not statistically significant.
Chronic nitrate treatment is associated with retinal venous dilatation in patients with glaucoma. Although not assessed in this study, it is possible that a protective effect of nitrates may be mediated by a vasoactive effect leading to improved perfusion of the retina and perhaps the optic nerve head, in a similar fashion to what has been observed in the circulation of the heart. Additional studies of the effect of nitrates on the ocular circulation are needed, however, to support this speculation.
最近一份报告表明，硝酸盐疗法可能会延缓青光眼性损害的进展。为了研究可能介导这种效应的机制，我们试图确定硝酸盐疗法是否与青光眼患者的视网膜血管扩张有关。
在一项旨在研究慢性硝酸盐治疗对青光眼病理进展的任何潜在影响的回顾性研究中，从视神经乳头的彩色眼底照片中确定视网膜静脉和动脉直径。随机选择14例因与青光眼无关的全身性疾病接受慢性硝酸盐治疗的患者的14只眼睛。将血管测量结果与15例未接受任何硝酸盐治疗的青光眼对照患者的15只眼睛的测量结果进行比较。
与对照患者相比，接受硝酸盐治疗的患者颞上和颞下视网膜静脉平均分别有17%（P = .008）和13%（P = .01）的显著血管扩张。视网膜动脉平均直径也有5%的增加，但这在统计学上不显著。
慢性硝酸盐治疗与青光眼患者的视网膜静脉扩张有关。尽管本研究未进行评估，但硝酸盐的保护作用可能是通过血管活性效应介导的，从而导致视网膜以及可能还有视神经乳头的灌注改善，这与在心脏循环中观察到的情况类似。然而，需要进一步研究硝酸盐对眼循环的影响来支持这一推测。
