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      Comparison of flow velocity in ophthalmic artery between glaucomatous and normal subjects

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          Purpose: To study the hemodynamic parameters in ophthalmic artery (OA) using color Doppler imaging in subjects with primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG) and age matched normals.

          Methods: Sixty-eight eyes of 68 subjects (41 males and 27 females) constituted material for this prospective observational study. They were divided into three groups; Group A had 24 patients with POAG, Group B had 18 patients with NTG and Group C had 26 normal subjects. They underwent CDI of OA. The outcome variables were peak systolic velocity (PSV), end diastolic velocity (EDV), resistivity index (RI) and pulsatility index (PI). Data were compiled and analyzed using one-way ANOVA analysis.

          Results: The mean ± SD age of POAG patients, NTG patient and normal subjects was 59.95 ± 7.35, 58.11 ± 9.97 and 57.73 ± 5.39 years, respectively. The mean intra ocular pressure (IOP) was 29.8 ± 5.0, 15.9 ± 2.4 and 16.6 ± 1.7mm Hg in Group A, B and C, respectively. In group A, the mean PSV, EDV, RI and PI were 18.2 ± 3.80, 3.71 ± 1.40, 0.93 ± 0.12 and 2.8 ± 0.42. In group B, 26.6 ± 1.72, 4.93 ± 1.32, 0.84 ± 0.02 and 1.32 ± 0.20 and in group C, 35.4 ± 3.04, 8.08 ± 0.69, 0.77 ± 0.03 and 1.80 ± 0.17, respectively. All the values were found to be statistically significant (p < 0.05). Lower PSV and EDV were found in POAG and NTG patients, while RI was higher than in normal subjects.

          Conclusion: The hemodynamic parameters are significantly affected in POAG and NTG patients. The PSV and EDV are decreased and RI is increased. EDV is more sensitive for the assessment of hemodynamic changes.

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          Most cited references 37

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          Nocturnal arterial hypotension and its role in optic nerve head and ocular ischemic disorders.

          We measured 24-hour ambulatory blood pressure monitoring and diurnal curve of the intraocular pressure in 166 white patients with anterior ischemic optic neuropathy, normal-tension glaucoma, primary open-angle glaucoma, and other optic nerve head disorders. Hourly average blood pressure data analyses showed a significant (P < .0001) decrease in mean systolic (26%) and diastolic (33%) blood pressure measurements at night. A significantly (P = .0028) lower nighttime mean diastolic blood pressure and a significantly (P = .0044) greater mean percentage decrease in diastolic blood pressure were noted in normal-tension glaucoma than in anterior ischemic optic neuropathy. Patients with arterial hypertension taking oral hypotensive therapy showed a significant association between progressive visual field deterioration and nocturnal hypotension, particularly in anterior ischemic optic neuropathy. Intraocular pressure showed no significant correlation with visual field deterioration in any of these conditions. Our findings suggest that nocturnal hypotension, in the presence of other vascular risk factors, may reduce the optic nerve head blood flow below a critical level, and thereby may play a role in the pathogenesis of anterior ischemic optic neuropathy and glaucomatous optic neuropathy; that is, nocturnal hypotension may be the final insult in a multifactorial situation. The same mechanisms may be true of a number of other ocular ischemic disorders. This finding opens a new dimension in the understanding and management of these visually disabling diseases.
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            Relationship between ocular perfusion pressure and retrobulbar blood flow in patients with glaucoma with progressive damage.

            To evaluate the relationship between ocular perfusion pressure and color Doppler measurements in patients with glaucoma. Twenty patients with primary open-angle glaucoma with visual field deterioration in spite of an intraocular pressure lowered below 21 mm Hg, 20 age-matched patients with glaucoma with stable visual fields, and 20 age-matched healthy controls were recruited. After a 20-minute rest in a supine position, intraocular pressure and color Doppler measurements parameters of the ophthalmic artery and the central retinal artery were obtained. Correlations between mean ocular perfusion pressure and color Doppler measurements parameters were determined. Patients with glaucoma showed a higher intraocular pressure (P <.0008) and a lower mean ocular perfusion pressure (P <.0045) compared with healthy subjects. Patients with deteriorating glaucoma showed a lower mean blood pressure (P =.033) and a lower end diastolic velocity in the central retinal artery (P =.0093) compared with normals. Mean ocular perfusion pressure correlated positively with end diastolic velocity in the ophthalmic artery (R = 0.66, P =.002) and central retinal artery (R = 0.74, P <.0001) and negatively with resistivity index in the ophthalmic artery (R = -0.70, P =.001) and central retinal artery (R = -0.62, P =.003) in patients with deteriorating glaucoma. Such correlations did not occur in patients with glaucoma with stable visual fields or in normal subjects. The correlations were statistically significantly different between the study groups (parallelism of regression lines in an analysis of covariance model) for end diastolic velocity (P =.001) and resistivity index (P =.0001) in the ophthalmic artery, as well as for end diastolic velocity (P =.0009) and resistivity index (P =. 001) in the central retinal artery. The present findings suggest that alterations in ocular blood flow regulation may contribute to the progression in glaucomatous damage.
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              Response of blood flow to warm and cold in normal and low-tension glaucoma patients.

              We measured blood flow in the finger in 38 control subjects with normal ocular findings without migraine, 13 control subjects with normal ocular findings with classic migraine, 17 patients with low-tension glaucoma with classic migraine, and 29 patients with low-tension glaucoma without migraine. Three blood flow measurements were recorded: one at baseline, one after immersion in warm water (40 C), and one after ten seconds' exposure to cold water (4 C). The mean baseline flow and the mean flow after exposure to cold was lower in patients with low-tension glaucoma (P = .013 and P less than .001, respectively).

                Author and article information

                Rom J Ophthalmol
                Rom J Ophthalmol
                Romanian Journal of Ophthalmology
                Romanian Society of Ophthalmology (Romania )
                Oct-Dec 2019
                : 63
                : 4
                : 346-353
                [* ]Department of Ophthalmology, Gajra Raja Medical College, Gwalior, India
                [** ]Comprehensive Ophthalmology, Mahatma Eye Institute, Nagpur
                [*** ]Department of Radiology, Gajra Raja Medical College (G.R.M.C), Gwalior, India
                Author notes
                Correspondence to: Ankita Aishwarya, Room no. 34, Senior Girls Hostel, J.A. Hospital Campus, Gwalior - 474001, India, Phone: +917000532739, E-mail: anki.twinki@gmail.com
                ©Romanian Society of Ophthalmology

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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