Elsevier

Ophthalmology

Volume 120, Issue 12, December 2013, Pages 2501-2507
Ophthalmology

Original article
Reduced Cerebrovascular Reactivity in Posterior Cerebral Arteries in Patients with Primary Open-Angle Glaucoma

https://doi.org/10.1016/j.ophtha.2013.05.017Get rights and content

Purpose

To evaluate the hemodynamics and vasoreactivity in the posterior cerebral artery (PCA) in patients with primary open-angle glaucoma (POAG).

Design

Case-control study.

Participants

Thirteen POAG patients (age range, 40–60 years) with marked visual field loss (mean deviation [MD], <−6 dB); a preserved, mostly normal, central visual field of at least 5°; and best-corrected visual acuity of at least 20/40 formed the study group. Exclusion criterion was presence or history of any systemic disorder including cardiovascular diseases. The control group consisted of 12 healthy subjects matched for age and sex with the study group.

Methods

Applying transcranial Doppler sonography, we measured hemodynamic parameters in both PCAs at baseline, under monocular reversing checkerboard stimulation, and under hyperventilation. The eye with more marked visual field loss was selected in glaucoma patients, whereas in controls, the tested eye was chosen randomly. Ipsilateral and contralateral PCA were defined according to the tested eye.

Main Outcome Measures

Peak systolic velocity (PSV), end-diastolic velocity, mean velocity (MV), MV change percentage (MV%), resistivity index (RI), pulsatility index (PI).

Results

At baseline, RI (0.55±0.04 vs. 0.52±0.03; P = 0.04) and PI (0.88±0.11 vs. 0.80±0.07; P = 0.04) in the ipsilateral PCA were significantly higher in glaucoma patients than in controls. During checkerboard stimulation, MV% in both PCAs were significantly smaller in the glaucoma group than in controls (19.7±7.2% and 19.0±8.3% vs. 30.7±7.9% and 27.5±9.0%, respectively; P = 0.001 and 0.02, respectively). During hyperventilation, glaucoma patients showed significantly lower MV% in the contralateral PCA than control subjects (−39.8±9.6% versus −47.4±7.0%; P = 0.03). Perimetric pattern standard deviation (PSD) in the tested eye was correlated significantly with RI and PI of the ipsilateral PCA during checkerboard stimulation (P = 0.003, r = −0.76; and P = 0.002, r = −0.76). The MV% of contralateral PCA was correlated inversely with PSD in the fellow eye (P = 0.02, r = −0.64). The difference in MV% between both PCAs was correlated positively with the difference in MD between 2 eyes (P = 0.003, r = 0.75). Under hyperventilation, PSV in the contralateral PCA was correlated negatively with the PSD in the fellow eye (P = 0.03, r = −0.60).

Conclusions

Vascular insufficiency in the PCAs may be associated with POAG. Changes in the vasoreactivity of PCAs to central visual stimulation may precede marked central visual field loss.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Methods

This hospital-based observational study included patients with POAG. Criteria for the diagnosis of POAG were an IOP measurement of more than 21 mmHg, an open and normal-appearing anterior chamber angle on gonioscopy, glaucomatous abnormalities of the optic nerve head, and visual field defects. Criteria for inclusion into the study were a visual field loss with mean deviation (MD) in the better-seeing eye of more than −6 dB, a preserved central visual field at least within the central 5°, a

Results

The study group included 13 POAG patients (11 men and 2 women) with a mean age of 47±7 years. The mean perimetric defect was −19.5±6.3 dB in the tested eye and −15.4±9.3 dB in the fellow eye, and the mean retinal nerve fiber layer thickness was 62.5±6.5 μm in the tested eye and 68.7±10.4 μm in the fellow eye. Intraocular pressure measured in the tested eye and the fellow eye of the patients was 17.1±4.9 and 15.3±3.7 mmHg, respectively. Eight patients had undergone glaucoma surgery, 3 patients

Discussion

In our study of patients with POAG and without systemic cardiovascular or central nervous system disorders, we investigated the hemodynamic characteristics of the PCA, the main vessel supplying the visual pathway posterior to the lateral geniculate ganglion. We observed disturbed hemodynamics in the PCA of POAG patients at baseline, after visual stimulation, and under hyperventilation. The glaucoma patients showed a significantly higher vasoresistance in the ipsilateral PCA at baseline, a

Acknowledgment

The authors thank Professor Jost B. Jonas for his tremendous help in revising the English language of this manuscript.

References (37)

  • A. Harris et al.

    Reduced cerebrovascular blood flow velocities and vasoreactivity in open-angle glaucoma

    Am J Ophthalmol

    (2003)
  • Y.H. Yucel et al.

    Paying attention to the cerebrovascular system in glaucoma

    Can J Ophthalmol

    (2008)
  • R.O. Duncan et al.

    Arterial spin labeling fMRI measurements of decreased blood flow in primary visual cortex correlates with decreased visual function in human glaucoma

    Vision Res

    (2012)
  • S. Zhang et al.

    Detection of early neuron degeneration and accompanying glial responses in the visual pathway in a rat model of acute intraocular hypertension

    Brain Res

    (2009)
  • M.C. Grieshaber et al.

    What is the link between vascular dysregulation and glaucoma?

    Surv Ophthalmol

    (2007)
  • Collaborative Normal-Tension Glaucoma Study Group

    Comparison of glaucomatous progression between untreated patients with normal-tension glaucoma and patients with therapeutically reduced intraocular pressures

    Am J Ophthalmol

    (1998)
  • D. Chang et al.

    The evaluation of the oxidative stress parameters in patients with primary angle-closure glaucoma

    PLoS One [serial online]

    (2011)
  • N.N. Osborne et al.

    Glutamate excitotoxicity in glaucoma: truth or fiction? By AJ Lotery [letter]

    Eye (Lond)

    (2006)
  • Cited by (0)

    Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Supported by the Postdoctoral Science Foundation of China (grant no.: 20100480170); the National Nature Science Foundation of China (grant no.: 81100661); and Key Lab Open Foundation of Capital Medical University, Beijing, China (grant no.: 2010YKSJ04).

    S.Z. and Y.X. contributed equally as first authors.

    View full text