A 10-year follow-up of the European multicenter trial of interferon ß-1b in secondary-progressive multiple sclerosis.

OBJECTIVES: To explore long-term effects of treatment and prognostic relevance of variables assessed at baseline and during the European secondary progressive multiple sclerosis (SPMS) trial of interferon beta 1b (IFNB-1b). METHODS: We assessed 362 patients (60% female; median age 41 years; Expanded Disability Status Scale (EDSS): 5.5; 51% randomized to IFNB-1b) for their EDSS and treatment history after 10 years. Non-parametric analysis of covariance (ANCOVA) and multivariate linear regression models were applied. RESULTS: Median EDSS was 6.0 at the end of the randomized controlled trial (RCT), in the IFNB-1b and placebo groups, and 7.0 in long-term follow-up patients (those receiving IFNB-1b in the RCT were 6.5 and those receiving placebo in the RCT were 7.0; p = 0.086). 24 patients (6.6%) were deceased. The EDSS at baseline and the EDSS change during the RCT were the most important predictors of the EDSS 10 years later (partial R(2): 0.47). The ability to predict changes in EDSS 10 years after the RCT was limited (R(2): 0.12). Magnetic resonance imaging (MRI) measures remained in the predictive models, but explained < 5% of the variability. CONCLUSIONS: The results from this analysis did not provide convincing evidence to support a favorable long-term outcome in those patients allocated IFNB-1b during the RCT, in our SPMS cohort. The progressive stage of the disease remains largely unpredictable by clinical and conventional MRI measures, so better prognostic markers are needed.

Analysis of risk factors for long-term glaucomatous damage development.

PURPOSE: The aim of this study was to analyze predictors of long-term glaucoma progression. PATIENTS AND METHODS: We followed 17 primary open angle glaucoma patients (POAG) and 25 ocular hypertensives (OHT) over three years, with regular follow-up examinations of both eyes every 6 months. Glaucoma damage was quantified by optical coherence tomography (retinal nerve fiber layer - OCT RNFL) and by perimetry. Corneal and hand temperature (infrared thermometer), corneal hysteresis, pachymetry and ocular pulse amplitude (OPA) readings were taken at baseline, and applanatory intraocular pressure and retinal vessel analysis recordings were made at baseline and follow-up visits. Forward-stepwise multiple regression analysis was performed. RESULTS: With OCT-RNFL progression as the dependent variable, the model selected initial diagnosis (OHT less probable of progressing), baseline RNFL thickness, retinal arterial and venous diameter and arterial flicker response as significant damage predictors. For visual field damage progression, these were: corneal temperature, OPA, initial diagnosis and venous flicker response (all p<0.05). CONCLUSION: Initial damage and vascular factors are strong predictors of future glaucoma progression.

[Analysis of retinal vein motion in glaucoma patients]. / Analyse der Venenbewegungen in der Netzhaut von Glaukompatienten.

BACKGROUND: Analysis of retinal vein amplitude in eyes of glaucoma patients. PATIENTS AND METHODS: Motion of retinal veins was captured by Retinal Vessel Analyzer in duration of 30 seconds. Inferotemporal vein segments of 500 micrometers length in the immediate vicinity of, as well as away from the optic disc were chosen. Time behavior of the average segment diameter was analyzed by the self made software: dominating frequency (heart rate) was determined by Fourier analysis, and based on this an average pulse form was produced. Difference between the highest and lowest diameter point was the subject of analysis in 25 eyes of 25 glaucoma patients and 25 age-sex-matched healthy controls. RESULTS: Pulse amplitude of retinal veins in healthy eyes was higher than in glaucoma patients: in the optic disc vicinity the pulse amplitude relative to baseline was 2.6 ± 2.1% in control eyes and 1.4 ± 0.8% in glaucoma eyes (t-test, p = 0.009). Away from the disc, it was 1.7 ± 1.0% and 1.1 ± 0.5% respectively (p = 0.01). CONCLUSIONS: Retinal veins in glaucoma eyes demonstrate lower pulse amplitudes than healthy eyes, indicating disturbance in venous outflow and increased intraluminal venous pressure.

Retinal neurovascular coupling in patients with glaucoma and ocular hypertension and its association with the level of glaucomatous damage.

PURPOSE: To analyze neurovascular coupling in the retina of untreated primary open-angle glaucoma (POAG) and ocular hypertension (OHT) patients. PATIENTS AND METHODS: Maximal vessel dilation in response to flicker light was analyzed with Retinal Vessel Analyzer (RVA) in temporal superior/inferior arterioles and veins in 51 POAG patients, 46 OHT and 59 control subjects. RVA parameters were compared between groups, between contralateral POAG eyes, and correlated to intraocular pressure, visual field mean defect and retinal nerve fiber layer thickness. RESULTS: POAG eyes demonstrated generally smaller response of all vessels to flicker light than the other two groups (ANOVA p=0.026; mean arterial flicker response in percent of baseline, averaged superior and inferior was 3.48 ± 2.22 % for controls , 2.35 ± 2.06 % for POAG patients , and 2.97 ± 2.35 % for OHT patients; corresponding values for venules were 3.88 ± 1.98 %, 2.89 ± 1.72 %, 3.45 ± 2.77 %). There was no difference in flicker response between the eye with more and less advanced damage in each patient of the POAG group (ANOVA p=0.79). Correlation of flicker response to intraocular pressure (IOP) was borderline at best, correlations to the level of glaucomatous damage were not significant. Correlation of flicker response of superior and inferior vessels of the same eye was significant for the arteries (Pearson r=0.23, p=0.004), as well as venules (r=0.52, p<0.001). CONCLUSION: General vessel response to flicker light was decreased in POAG patients, compared to normal controls and OHT patients. In contrast to significant correlation between the two contralateral eyes of the flicker response itself, only its borderline correlation to IOP was seen. There was no correlation to the level of damage, altogether indicating a systemic dysregulation phenomenon. GRANTS: Swiss National Foundation Grant 3200B0-113685, Velux Stiftung Grant, Freie Akademische Gesellschaft (FAG) Grant, Pfizer Inc. Grant CLINICAL TRIAL REGISTRATION REFERENCE NUMBER: ClinicalTrials.gov NCT00430209.

Dynamics of retinal vessel response to flicker light in glaucoma patients and ocular hypertensives.

PURPOSE: To analyze dynamics of retinal vessel dilation response to flicker light in patients with glaucoma and ocular hypertension. PATIENTS AND METHODS: Response to flicker light was measured in retinal vessels by means of Retinal Vessel Analyzer. After the baseline 50 seconds long diameter recording of inferior and superior temporal artery and vein, three flicker stimulations of 20 seconds duration was applied, with a 80 seconds break in between. Area under the curve of the vessel diameter (AUC) was compared during 3 flicker periods in the open angle glaucoma patients group (POAG, n = 47) and ocular hypertensives (OHT, n = 46) and age-matched healthy controls (n = 56) RESULTS: POAG eyes demonstrated smaller response of all vessels to flicker light in general than the other two groups (p = 0.0008), but the response dynamics was significantly different between the groups (p = 0.038), showing in three flicker periods a delayed increasing response in the POAG and OHT groups, and remaining stable in healthy subjects. CONCLUSION: General vessel response to flicker light was decreased in POAG patients despite the slow improvement in repeated flicker stimulation, indicating an altered response pattern.

Relationship between peripheral blood flow in extremities and choroidal circulation.

BACKGROUND: The aim of this study was to explore the relationship between subjectively estimated and objectively measured finger temperature on the one, and choroidal blood flow on the other side. PATIENTS AND METHODS: We measured submacular choroidal blood flow (CBF) in 73 healthy subjects. Based on the history of cold hands and feet, they were divided in three groups, reporting "never", "sometimes" and "always" having cold extremities. As an objective measure of finger temperature, it was recorded at the fingertips with an infrared thermometer (IRT). Analysis of variance for CBF based on the group selection and with blood and intraocular pressures as covariates was performed, as well as the correlation between CBF and IRT. RESULTS: There were 37 subjects in the group with "never" cold extremities, 20 in the group with "sometimes", and 16 subjects in the group with "always" cold extremities. Average age was 44.2 ± 12.9 years. CBF was 11.5 ± 7.3 AU (arbitrary units), 13.6 ± 6.1 AU and 14.3 ± 4.6 AU in the three groups, respectively. The ANOVA p-value was 0.04. Pearson's R for correlation between CBF and IRT was - 0.51, p < 0.001. CONCLUSION: Subjectively and objectively, colder extremities are associated with higher CBF, possibly due to the redistribution of blood flow.

Olfactory function in primary open-angle glaucoma patients.

PURPOSE: The aim of this study was to assess the olfactory function of primary open-angle glaucoma patients. PATIENTS AND METHODS: We analyzed odour threshold, identification, and discrimination in 30 primary open-angle glaucoma patients and 30 age- and gender-matched healthy control subjects. The "Sniffin' Sticks" test battery was applied sequentially on both sides, scores of two nostrils were averaged and means were compared with Mann-Whitney U-test between the groups. RESULTS: Scores for odour threshold were 5.9 +/- 2.2 and 7.4 +/- 2.1 in glaucoma and control group, respectively (p = 0.01), for odour discrimination 10.5 +/- 2.0 and 10.8 +/- 1.6 (p = 0.65), and for odour identification 11.8 +/- 2.1 and 10.6 +/- 1.6 (p = 0.008). Comparing within glaucoma group between those with (n = 18) and without history (n = 12) of cold hands and feet, the former had significantly better odour threshold scores, 6.6 +/- 1.5, than the latter, 4.8 +/- 2.6 (p = 0.036); no difference in other two olfactory modalities were detected. CONCLUSION: Changes of olfactory function have been described in neurodegenerations such as Alzheimer and Parkinson diseases. Complex alterations of olfactory performance seem to be present in POAG patients as well.

Volumetric blood flow measurement in the ophthalmic artery using colour Doppler.

BACKGROUND: Herewith we present a new method for measurement of the volumetric blood flow in absolute units in the ophthalmic artery. PATIENTS AND METHODS: A Philips EnVisor HD ultrasound unit with a 12 - 3 MHz linear transducer was used to measure flow in the ophthalmic artery in 8 healthy young subjects. The transducer was mounted on a custom-made holder which enabled precise and reproducible positioning in 3 axes as well as in rotation angle. Blood flow velocity and vessel diameter were measured during 10 consecutive heartbeats. The measurements were ECG-gated. Blood vessel diameter and blood flow velocity were calculated in an average heartbeat cycle. Hence blood volume over time within a heartbeat cycle as well as blood flow in mL/min were determined. Simultaneously, cardiovascular parameters have been recorded by Finapres. Short time reproducibility (5 measurements on day 1) and long time reproducibility (5 days once daily) as well as interindividual coefficient of variation were evaluated. RESULTS: Average blood flow in the ophthalmic artery in all measurements was 39.7 mL/min. The short-term intraindividual coefficient of variation was 24.1 +/- 9.2 %, the long-term coefficient 32.0 +/- 13.8 %. Interindividual coefficient of variation was 32.8 %. CONCLUSIONS: Our method allows volumetric blood flow measurements in the ophthalmic artery in absolute units, reproducible to a limited extent.

Retinal vessels in patients with multiple sclerosis: baseline diameter and response to flicker light stimulation.

BACKGROUND: Transparency of ocular media enables the precise quantitative analysis of vessels of retina, a neuronal tissue which can be affected by multiple sclerosis (MS). PATIENTS AND METHODS: Eyes with no history of optic neuritis (non-ON eyes) of 21 patients with MS were examined with Retinal Vessel Analyzer. Segments of vessels of 500 microm length were measured proximal and distal from the optic disc and compared to those of 21 age- and gender-matched controls. Baseline diameters and peak response to flicker light stimulation of retinal vessels were analyzed. RESULTS: MS eyes had thinner arterioles (p = 0.02) and thicker venules (p = 0.008) than controls: arterioles 111 +/- 14 microm (proximal), 99 +/- 11 microm (distal) in MS eyes and 121 +/- 15 and 107 +/- 9 in controls, respectively. Values for venules were 157 +/- 18 and 136 +/- 20 (MS); 147 +/- 15 and 119 +/- 20 (controls). Peak response was higher in MS eyes than in controls for arterioles (p = 0.007), but comparable for venules (p = 0.35). CONCLUSION: Narrower arterioles and wider venules might be a consequence of subclinical swelling of optic nerve axons in eyes with negative history of ON in MS patients.

Rigidity of retinal vessels in patients with multiple sclerosis.

PURPOSE: The aim of this study was to analyze pulse wave propagation in the ocular circulation by assessing the phase delay between retinal arterioles and venules and calculating the pulse delay between the retinal and choroidal circulations in MS patients and in control subjects. SUBJECTS AND METHODS: Twenty patients with multiple sclerosis (38.3 +/- 6.2 years) and twenty healthy subjects (37.4 +/- 15.2 years) were examined with the Retinal Vessel Analyzer. In addition, an average peripapillary RNFL (retinal nerve fiber layer) thickness was measured by means of ocular coherence tomography in MS patients. The phase delay between the arteriole and venule pulsations was assessed at three sites: in the close retinal vicinity of the disc, 1 - 2 disc diameters and 3 - 4 disc diameters away from the disc. Assuming that venules are counterphased to the choroidal circulation, a choroid-to-retina pulse delay was calculated. RESULTS: The choroid-to-retina pulse delay was 0.26 +/- 0.11, 0.27 +/- 0.13 and 0.34 +/- 0.15 sec in eyes with history of optic neuritis (ON-eyes); in eyes of MS patients without such a history (non-ON eyes) the corresponding values were 0.27 +/- 0.14, 0.29 +/- 0.11 and 0.30 +/- 0.15 sec, and in control eyes 0.32 +/- 0.19, 0.38 +/- 0.16 and 0.45 +/- 0.20 sec, respectively, at three sites centrifugal from the disc. The choroid-to-retina pulse delay was significantly longer in healthy control eyes than both in ON eyes (p = 0.012) and non-ON eyes of MS patients (p = 0.004). The interocular difference of the choroid-to-retina pulse delay and OCT RNFL thickness showed a significant correlation in MS patients (Pearson r = 0.54, p = 0.015; Spearman R = 0.66, p = 0.0016). CONCLUSION: Patients with multiple sclerosis seem to demonstrate an increased rigidity of the retinal vessels. The interocular difference in retinal vessel rigidity was significantly correlated with the interocular difference in RNFL thickness in MS patients.

[Response of retinal vessel diameter to flicker-light in vasospastics compared to healthy controls]. / Flickerlichtprovokation bei Vasospastikern verglichen mit gesunden Kontrollpersonen.

BACKGROUND: Vascular dysregulation is considered to be a risk factor in several ophthalmic diseases. The purpose of this study was to evaluate the reaction of retinal vessels to flicker light in otherwise healthy subjects with a vasospastic propensity. PATIENTS AND METHODS: Thirty healthy Caucasians, aged between 18-35 years were recruited for this study and grouped into vasospastics, based on a history of frequent cold hands, even in summer, with concordant findings in nailfold capillary microscopy, or as controls, if such a history was absent. The reaction of the retinal vascular diameter to flicker light was observed in a distance of two to three discs diameters away from the optic nerve head with the retinal vessel analyser. Three phases of flicker light of twenty seconds followed by baseline light phases of eighty seconds were recorded. The maximal vasodilatory amplitude of each flicker phase was determined and the results averaged. RESULTS: The maximal average dilatory amplitude at the arterial side reached (mean +/- SD) 2.9 +/- 1.7 % and 4.8 +/- 2.6 % of the baseline amplitude respectively in vasospastic subjects and in healthy controls (t = 2.34; p = 0.025). The reaction at the venous side was statistically comparable in both groups. CONCLUSIONS: Otherwise healthy, vasospastic subject disclosed an altered reaction of the retinal vasculature to flicker light in this study.

Relation of body mass index and blood pressure to subjective and objective acral temperature.

BACKGROUND: Vascular dysregulation, indicated by a positive history of cold extremities, has been postulated as a risk factor for a number of ocular diseases. In order to further characterize the phenotype of vasospastic persons, we tested the association between cold extremities, body mass index (BMI) and blood pressure (BP) in a cohort of healthy subjects. PATIENTS AND METHODS: Questionnaire data were collected from one hundred and seventeen healthy subjects. Based on the history of cold hands and feet they were divided in three groups, reporting "never", "sometimes" and "always" having cold extremities. BP was measured sphygmomanometrically and as an objective measure of finger temperature, it was recorded at the fingertips with an infrared thermometer (IRT). Two-way analysis of variance with gender as one, and group selection as the second factor was performed separately for BMI and mean BP. The correlation of finger temperature with BMI and BP was analyzed by the Pearson regression. RESULTS: Gender distribution was male/female = 41/16, 13/21 and 4/22, for the three groups, respectively, and average age 45.8 +/- 13.0 years. For BMI, factor groups was highly significant (p = 0.0012) with both genders behaving comparably (interaction p = 0.18). For BP the corresponding p values were: factor group p = 0.026, interaction p = 0.89. Correlation coefficients between IRT and BMI were 0.34 (p = 0.0002) and between IRT and BP 0.24 (p = 0.009). CONCLUSION: A statistical significant association is present in healthy subjects between body mass index and blood pressure on one, and cold extremities on the other side, defined subjectively as well as measured objectively. This relationship is gender-independent.

[Vascular risk factors in glaucoma - diagnostics]. / Vaskuläre Risikofaktoren beim Glaukom - Diagnostik.

The major risk factor for glaucoma is the increased intraocular pressure, and its pharmacological and/or surgical reduction slows down the progression of the glaucomatous damage. However, this protective effect is only a partial one, the complete arrest of damage progression does not take place, indicating risk factors other than intraocular pressure. Among vascular factors, reduced ocular perfusion pressure, in particular the nocturnal episodes of arterial hypotony, and the vascular dysregulation play important roles in glaucoma. Combined with variable intraocular pressure, these factors lead to oxidative stress, reperfusion damage and ultimately to the hallmark of glaucoma - loss of axons and tissue remodelling (cupping). Examination of vascular risk profile is necessary in order to tailor the therapy to the patients individual need.

Resting energy expenditure in vasospastic subjects and its potential relevance in glaucoma.

BACKGROUND: Peripheral vasospastic syndrome is frequently encountered in normal tension glaucoma patients. We tested the hypothesis as to whether peripheral vascular spastic tendency is due to an attempt to preserve body heat in subjects with reduced resting energy expenditure. PATIENTS AND METHODS: Twenty healthy non-smoking female individuals were enrolled into the study. Subjects were classified as having vasospasm (10 subjects) if they related a clear history of frequent cold hands, and as normal subjects (10 subjects) if they denied such a history. Sample size calculation was based on a power of 80 % to find a difference of 20 %. Resting energy expenditure (REE) was assessed by indirect calorimetry and corrected for fat-free mass (FFM), which was assessed by bioelectric impedance analysis. RESULTS: REE was 1198 +/- 155 kilocalories (kcal) in vasospastics and 1169 +/- 122 in controls (Mann-Whitney U-test: p = 0.62). FFM was 39.6 +/- 3.3 kg in vasospastics and 41.1 +/- 2.3 kg in controls (Mann-Whitney U-test: p = 0.16). REE adjusted for FFM was 30.2 +/- 2.5 kcal/kg in vasospastics and 28.4 +/- 2.3 kcal/kg in controls (Mann-Whitney U-test: p = 0.08). CONCLUSIONS: Peripheral vasospastic syndrome seems not to be a secondary response to insufficient resting energy expenditure. The results of the present study rather indicate an opposite tendency which deserves further investigation.

Pattern of macular thickness changes measured by ocular coherence tomography in patients with multiple sclerosis.

BACKGROUND: An analysis of the pattern of retinal thickness changes in macula in patients with multiple sclerosis (MS) was performed. PATIENTS AND METHODS: In fifteen patients with MS retinal thickness measurements in the central (fovea plus inner macular ring) and peripheral (outer ring) macula obtained by ocular coherence tomography (OCT-3 device) were compared to those of 15 age-matched healthy controls. RESULTS: Eyes of MS patients had on the average a thinner macula (241.8 +/- 20.6 micrometers) than control eyes (252.0 +/- 16.4, p value 0.038). Significant segmental differences occurred in the central macula (p = 0.013). Eight eyes with a positive history of optic neuritis (ON) had on average a thinner macula (226.8 +/- 14.0) than eyes of MS patients without a history of ON (non-ON eyes: 247.3 +/- 20.1, p value 0.01). The only measure significantly different between non-ON and control eyes was the ratio between the central and peripheral macular thickness (p = 0.017). Average macular thickness in non-ON eyes, unlike control eyes (r = - 0.63, p = 0.0002), did not correlate with age (r = 0.01, p = 0.97), however, it did show a borderline correlation with disease duration (r = - 0.41, p = 0.056). CONCLUSIONS: Preferential thinning in the central relative to the peripheral macular region is present in eyes of patients with MS. The macular thickness pattern is likely due to the histological distribution of nerve fibre layer and retinal ganglion cell in the macular area and seems to be particularly informative of neurodegeneration in the eyes of MS patients without a history of optic neuritis.

Ocular blood flow alteration in glaucoma is related to systemic vascular dysregulation.

AIMS: To investigate the source of ocular blood flow alterations in glaucoma. METHODS: In 56 patients with open angle glaucoma, blood flow parameters were obtained from both eyes in the ophthalmic and central retinal artery by means of colour Doppler imaging, as well as in the choroidal circulation and the neuroretinal rim of the optic nerve by means of laser Doppler flowmetry. Based on these haemodynamic parameters, a cluster analysis (two groups) was performed and differences with regard to risk factors were assessed between clusters. RESULTS: Ocular blood flow data in the two clusters indicated that the two groups (cluster 1 = 26 patient with higher blood flow values; cluster 2 = 30 patients with lower blood flow values) differed mainly in choroidal and optic nerve blood flow. No differences in sex distribution, propensity to have normal tension glaucoma, age, endothelin-1 plasma levels, visual field damage, intraocular pressure, or systemic blood pressure parameters were observed between the two clusters. However, 12 patients (46%) from the cluster with high ocular blood flow values showed a vasospastic response in nailfold capillaroscopy, while such a response was observed in 24 patients (80%) of the cluster with low ocular blood flow values. This difference in vasospastic propensity was statistically significant (p = 0.0121). CONCLUSIONS: Ocular blood flow alterations in glaucoma patients seem, at least partly, to be related to a systemic vascular dysregulation.

Retrobulbar blood flow in glaucoma patients with nocturnal over-dipping in systemic blood pressure.

PURPOSE: To evaluate the relationship between the circadian blood pressure rhythm and the retrobulbar blood flow in glaucoma patients. DESIGN: Cross-sectional study. METHODS: Circadian blood pressure measurements and color Doppler imaging (CDI) in the ophthalmic artery as well as the central retinal artery of one randomly selected eye were obtained in 193 primary open-angle glaucoma patients. CDI parameters were compared by means of analysis of covariance between patients with a nocturnal decrease in mean systemic blood pressure (MBP) below 20% of the average daytime MBP (over-dippers), patients with a decrease between 10% to 20% (dippers), and patients with a decrease of less than 10% (nondippers), using age, intraocular pressure (IOP), and MBP during color Doppler measurement as covariates. RESULTS: An analysis of covariance disclosed, after correcting for age, IOP, and MBP during color Doppler imaging, a significantly lower EDV (P =.0096) and a significantly higher RI (P =.033) in the central artery of over-dipping glaucoma patients compared with nondippers or dippers. This effect seemed independent of the use of vasoactive drugs . CONCLUSIONS: Glaucoma patients with a marked drop in nocturnal systemic blood pressure seem to have altered retrobulbar blood flow parameters, suggesting that an abnormal systemic blood pressure profile may be the manifestation of some kind of systemic vascular dysregulation relevant for the ocular circulation.

The influence of sex difference in measurements with the Langham Ocular Blood Flow System.

PURPOSE: To assess sex difference and parameters possibly accounting for such a difference in healthy subjects evaluated by means of the Langham Ocular Blood Flow (OBF) System. METHODS: Pulse amplitude of intraocular pressure (IOP) and pulsatile ocular blood flow (POBF) as measured with the Langham OBF System were assessed in 86 healthy men and 69 healthy women. RESULTS: Compared to men, women showed higher POBF (mean +/- SD: 722.6 +/- 152.8 versus 647.8 +/- 164.9 microL/min; P =.0056) and pulse amplitude (mean +/- SD: 2.3 +/- 0.7 versus 2.0 +/- 0.6 mm Hg; P =.0043) values. Sex difference was still significant after correcting for age, refraction, blood pressure, IOP, and pulse rate. Pulse amplitude correlated negatively with pulse rate, and POBF correlated negatively with IOP. Women had higher readings in pulse amplitude and POBF, even after correcting for age, refraction, IOP, blood pressure, and pulse rate. CONCLUSIONS: While using the Langham OBF System, one needs to be aware of sex difference that is independent of other hemodynamic parameters. How the observed difference in POBF is related to ocular blood flow, and how it might influence the preponderance of various ocular diseases in men or women remains to be clarified.

An evaluation of the effect of unoprostone isopropyl 0.15% on ocular hemodynamics in normal-tension glaucoma patients.

BACKGROUND: Because intraocular pressure-lowering agents should have a good safety profile with regard to ocular hemodynamics, the innocuousness of unoprostone isopropyl 0.15% with regard to ocular hemodynamics in vasospastic patients with normal-tension glaucoma was assessed in a pilot study. METHODS: Corneal temperature as a parameter of ocular blood flow and choroidal and optic nerve blood flow as assessed by means of laser Doppler flowmetry techniques were evaluated in 12 vasospastic normal-tension glaucoma patients in a prospective, randomized, observer-masked, two-period crossover, placebo-controlled pilot trial. RESULTS: Statistical analysis in 2 x 2 two-way analysis of variance models with two treatments (placebo and unoprostone isopropyl) and two assessments (baseline and after 1 week of treatment) as within-subject factors disclosed a lack of difference between eyes, between the treatment (placebo/unoprostone isopropyl) periods, and between baseline and after 1 week of treatment in corneal temperature, choroidal blood flow, and optic nerve blood flow. The differences between the results at baseline and after 1 week of treatment in these parameters were not significantly different between the placebo treatment period and the unoprostone isopropyl treatment period, and this was comparable in fellow eyes for all the parameters. CONCLUSION: Unoprostone isopropyl did not induce any alterations in ocular hemodynamics in this pilot study with vasospastic normal-tension glaucoma patients.