Arteriovenous passage times and visual field progression in normal tension glaucoma.

PURPOSE: Fluorescein angiographic studies revealed prolonged arteriovenous passage (AVP) times and increased fluorescein filling defects in normal tension glaucoma (NTG) compared to healthy controls. The purpose of this study was to correlate baseline AVP and fluorescein filling defects with visual field progression in patients with NTG. PATIENTS AND METHODS: Patients with a follow-up period of at least 3 years and at least 4 visual field examinations were included in this retrospective study. Fluorescein angiography was performed at baseline using a confocal scanning laser ophthalmoscope (SLO, Rodenstock Instr.); fluorescein filling defects and AVP were measured by digital image analysis and dye dilution curves (25 Hz). Visual field progression was evaluated using regression analysis of the MD (Humphrey-Zeiss, SITA-24-2, MD progression per year (dB/year)). 72 patients with NTG were included, 44 patients in study 1 (fluorescein filling defects) and 28 patients in study 2 (AVP). RESULTS: In study 1 (mean follow-up 6.6 ± 1.9 years, 10 ± 5 visual field tests), MD progression per year (-0.51 ± 0.59 dB/year) was significantly correlated to the age (P = 0.04, r = -0.29) but not to fluorescein filling defects, IOP, or MD at baseline. In study 2 (mean follow-up 6.6 ± 2.2 years, 10 ± 5 visual field tests), MD progression per year (-0.45 ± 0.51 dB/year) was significantly correlated to AVP (P = 0.03, r = 0.39) but not to age, IOP, or MD at baseline. CONCLUSION: Longer AVP times at baseline are correlated to visual field progression in NTG. Impaired retinal blood flow seems to be an important factor for glaucoma progression.

Fluorescein leakage of the optic disc: time course in primary open-angle glaucoma.

PURPOSE: To identify and quantify the time course of fluorescein leakage of the optic nerve head in primary open-angle glaucoma (POAG) and controls. METHODS: Twenty patients with POAG (aged 58 +/- 10 years) and 14 controls (aged 51 +/- 12 years, p = 0.07) were included in a prospective study. Fluorescein leakage of the optic disc was quantified using digital image analysis. A new leakage ratio (fluorescence of the optic disc divided by fluorescence of the surrounding retina) was defined and fluorescein leakage was quantified at 7-8, 9-10, 11-12, and 13-14 min after injection of 2.5 cc sodium fluorescein (10%). RESULTS: The fluorescein leakage exhibited a significantly different time course with higher leakage ratio values in POAG compared to controls (7-8 min: 1.24 +/- 0.32 vs 1.16 +/- 0.12; 9-10 min: 1.37 +/- 0.37 vs 1.19 +/- 0.1; 11-12 min: 1.38 +/- 0.36 vs 1.24 +/- 0.13; 13-14 min: 1.44 +/- 0.36 vs 1.27 +/- 0.13; p = 0.004). The change in optic disc fluorescence from 7-8 min to 9-10 min was significantly higher in POAG compared to controls (0.13 +/- 0.09 vs 0.03 +/- 0.07; p = 0.002). CONCLUSION: The time course of fluorescein leakage is significantly different in POAG compared to controls. This might reflect damage of the optic disc vasculature related to increased vascular permeability.

Acute Effect of Hypervolemic Hemodilution on Retrobulbar Hemodynamics in Anterior Ischemic Optic Neuropathy.

PURPOSE: Ischemic ocular disorders may be treated by hypervolemic hemodilution. The presumed therapeutic benefit is based on a volume effect and improved rheological factors. The aim was to investigate the acute effect of intravenous hydroxyethyl starch on retrobulbar hemodynamics in patients with nonarteritic anterior ischemic optic neuropathy (NAION). METHODS: 24 patients with acute NAION were included. Retrobulbar hemodynamics were measured using color Doppler imaging before and 15 min after intravenous infusion of 250 cc 10% hydroxyethyl starch (HES). Peak systolic velocity (PSV), end diastolic velocity (EDV), and Pourcelot's resistive index (RI) were measured in the ophthalmic artery (OA), central retinal artery (CRA), and short posterior ciliary arteries (PCAs). RESULTS: After infusion of HES blood flow velocities significantly increased in the CRA (PSV from 7.53 ± 2.33 to 8.32 ± 2.51 (p < 0.001); EDV from 2.16 ± 0.56 to 2.34 ± 0.55 (p < 0.05)) and in the PCAs (PSV from 7.18 ± 1.62 to 7.56 ± 1.55 (p < 0.01); EDV from 2.48 ± 0.55 to 2.66 ± 0.6 cm/sec (p < 0.01)). The RI of all retrobulbar vessels remained unaffected. Blood pressure and heart rate remained unchanged. CONCLUSIONS: Hypervolemic hemodilution has an acute effect on blood flow velocities in the CRA and PCAs in NAION patients. Increased blood flow in the arteries supplying the optic nerve head may lead to a better perfusion in NAION patients. This trial is registered with DRKS00012603.

Optic disc fluorescein leakage and intraocular pressure in primary open-angle glaucoma.

PURPOSE: To investigate the relationship between increased fluorescein leakage of the optic nerve head and intraocular pressure (IOP), visual field defect, vertical cup-to-disc ratio, disc size and systemic blood pressure in primary open-angle glaucoma (POAG). METHODS: Twenty-seven patients with POAG (aged 63 ± 11 years) and 15 control subjects (aged 58 ± 9 years, p = 0.14) were included in a pilot study. Fluorescein angiography was performed using a Scanning Laser Ophthalmoscope (Rodenstock Instruments, Germany). Fluorescein leakage of the optic disc was quantified using digital image analysis. The change of optic disc fluorescence from 7-8 min to 9-10 min was calculated and correlated to IOP, visual field mean deviation (MD), vertical cup-to-disc ratio, disc size, mean arterial blood pressure (MAP) and ocular perfusion pressure. RESULTS: The change in optic disc fluorescein leakage was significantly increased in patients with POAG compared to control subjects (POAG: 9.7 ± 6.7%; controls: 3.4 ± 4.9%, p = 0.0025). In POAG, fluorescein leakage was significantly correlated to IOP (r = 0.42, p = 0.029), but not to MD (r = -0.13, p = 0.51), vertical cup-to-disc ratio (r = 0.11, p = 0.60) disc size (r = -0.22, p = 0.30), MAP (r = -0.16, p = 0.42) or ocular perfusion pressure (r = -0.32, p = 0.10). In control subjects, a significant correlation was found with vertical cup-to-disc ratios (r = 0.59, p = 0.034), but not to IOP (r = -0.07, p = 0.80), MD (r = -0.26, p = 0.42), disc size (r = -0.10, p = 0.76), MAP (r = 0.09, p = 0.77), or ocular perfusion pressure (r = 0.11, p = 0.72). CONCLUSION: Increased fluorescein leakage of the optic disc was associated with higher IOP levels in patients with POAG. This might reflect a link between vascular damage with increased permeability and uncontrolled IOP.

Observational study results in glaucoma patients undergoing a regimen replacement to fixed combination travoprost 0.004%/timolol 0.5% in Germany.

With the launch of the fixed combination of travoprost 0.004%/timolol 0.5% (trav/tim) in Germany in May 2006, a noninterventional observational study designed as an open-label, multicenter, 6-week trial was initiated in order to evaluate the efficacy and tolerability of this new drug combination in glaucoma patients. Participants were grouped into categories according to previous drug regimens: those on timolol monotherapy; those on prostaglandin analog (PGA) monotherapy; those on concomitant therapy with a PGA and timolol; and those on fixed combinations. Trav/tim was well accepted by the patients, with 87.9% judging the tolerability of the therapy as good, very good, or excellent. Analysis of intraocular pressure (IOP) measurements showed statistically significant IOP decreases in all four categories examined in our study after regimen substitution with fixed-combination trav/tim. Fixed-combination prostaglandin analog/beta-blocker formulations are an attractive therapeutic option due to their strong IOP-lowering efficacy with once-daily dosing. In this study, glaucoma patients who underwent a regimen modification to fixed-combination trav/tim showed further reductions in IOP, irrespective of which selected monoor multiple therapies had been used previously.

Prolonged retinal arteriovenous passage time is correlated to ocular perfusion pressure in normal tension glaucoma.

BACKGROUND: The pathogenesis of normal tension glaucoma (NTG) might be related to impaired autoregulation of ocular blood flow. The purpose of the study is to evaluate retinal haemodynamics by fluorescein angiography and to correlate arteriovenous passage times (AVP) with ocular perfusion pressure in patients with NTG and controls. METHODS: Thirty-five patients with NTG without any topical treatment (mean age 53 +/- 11 years) and 35 age-matched controls (mean age 53 +/- 11 years) were included in this study. Retinal AVP was assessed by video fluorescein angiography using a scanning laser ophthalmoscope (Rodenstock, Germany). Dye dilution curves of temporal superior and inferior arterioles and venules were evaluated by digital image analysis. AVP was correlated to mean arterial blood pressure and ocular perfusion pressure. RESULTS: The AVP was significantly prolonged in patients with NTG compared to controls (1.82 +/- 0.57 versus 1.42 +/- 0.46, p = 0.002). Patients with NTG and controls showed no significant differences in intraocular pressure, mean arterial pressure and mean and diastolic ocular perfusion pressure. The AVP was significantly correlated to mean arterial pressure and mean and diastolic ocular perfusion pressure in patients with NTG (r = -0.54; p = 0.0006, r = -0.51; p = 0.002, r = -0.49, p = 0.002), but not in controls (r = -0.21; p = 0.23, r = -0.19; p = 0.27, r = 0.02, p = 0.93). CONCLUSIONS: Patients with NTG exhibit prolonged retinal AVP compared to controls. A significant correlation of retinal haemodynamics to mean arterial blood pressure and ocular perfusion pressure might reflect impaired autoregulation in NTG.