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Abstract
To assess whether a low cerebrospinal fluid pressure (CSF-P) is associated with open-angle
glaucoma in eyes with normal intraocular pressure (IOP).
Prospective, interventional study.
The study included 43 patients with open-angle glaucoma (14 with a normal IOP, and
29 with an elevated IOP) and 71 subjects without glaucoma.
All patients underwent standardized ophthalmologic and neurologic examinations and
measurement of lumbar CSF-P.
Cerebrospinal fluid pressure and IOP.
Lumbar CSF-P was significantly (P<0.001) lower in the normal IOP glaucoma group (9.5+/-2.2
mmHg) than in the high IOP glaucoma group (11.7+/-2.7 mmHg) or the control group (12.9+/-1.9
mmHg). The trans-lamina cribrosa pressure difference (IOP minus CSF-P) was significantly
(P<0.001) higher in the normal IOP glaucoma group (6.6+/-3.6 mmHg) and the high-IOP
glaucoma group (12.5+/-4.1 mmHg) than in the control group (1.4+/-1.7 mmHg). The extent
of glaucomatous visual field loss was negatively correlated with the height of the
CSF-P and positively correlated with the trans-lamina cribrosa pressure difference.
In the control group, CSF-P was significantly correlated with both systolic blood
pressure (P = 0.04) and IOP (P<0.001). The trans-lamina cribrosa pressure difference
was not significantly associated with blood pressure (P = 0.97).
In open-angle glaucoma with normal IOP, CSF-P is abnormally low, leading to an abnormally
high trans-lamina cribrosa pressure difference. Pathogenetically, a low CSF-P in normal-IOP
glaucoma may be similar to a high IOP in high-IOP glaucoma. Consequently, the glaucomatous
visual field defect is positively correlated with the trans-lamina cribrosa pressure
difference and inversely correlated with the CSF-P. In nonglaucomatous subjects, CSF-P,
blood pressure, and IOP are significantly associated with each other.
Copyright (c) 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All
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