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      Short-Term Effects of Ginkgo biloba Extract on Peripapillary Retinal Blood Flow in Normal Tension Glaucoma

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          Abstract

          Purpose

          Based on the vascular theory of glaucoma pathogenesis, we wanted to evaluate the effect of Ginkgo biloba extract (GBE) on peripapillary blood flow in patients with normal tension glaucoma (NTG).

          Methods

          Thirty patients with NTG were randomly placed in the GBE-treated or control groups. The GBE-treated group received 80 mg GBE orally, twice a day for four weeks, and the control group received a placebo twice a day for four weeks. Complete ocular examinations including visual field, Heidelberg retina flowmeter, and systemic examinations were performed on the first study day and on the day treatment was completed.

          Results

          After GBE treatment, the mean blood flow, volume, and velocity increased at almost all points, and there was a statistically significant increase in blood flow at almost all points, in comparison to the placebo. Blood volume significantly increased only in the superior nasal and superior temporal neuroretinal rim areas. GBE also significantly increased blood velocity in areas of the inferior temporal neuroretinal rim and superior temporal peripapillary area.

          Conclusions

          GBE administration appears to have desirable effect on ocular blood flow in NTG patients.

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          Most cited references29

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          The impact of ocular blood flow in glaucoma.

          Josef Flammer, Selim Orgül, Vital P. Costa … (2002)
          Two principal theories for the pathogenesis of glaucomatous optic neuropathy (GON) have been described--a mechanical and a vascular theory. Both have been defended by various research groups over the past 150 years. According to the mechanical theory, increased intraocular pressure (IOP) causes stretching of the laminar beams and damage to retinal ganglion cell axons. The vascular theory of glaucoma considers GON as a consequence of insufficient blood supply due to either increased IOP or other risk factors reducing ocular blood flow (OBF). A number of conditions such as congenital glaucoma, angle-closure glaucoma or secondary glaucomas clearly show that increased IOP is sufficient to lead to GON. However, a number of observations such as the existence of normal-tension glaucoma cannot be satisfactorily explained by a pressure theory alone. Indeed, the vast majority of published studies dealing with blood flow report a reduced ocular perfusion in glaucoma patients compared with normal subjects. The fact that the reduction of OBF often precedes the damage and blood flow can also be reduced in other parts of the body of glaucoma patients, indicate that the hemodynamic alterations may at least partially be primary. The major cause of this reduction is not atherosclerosis, but rather a vascular dysregulation, leading to both low perfusion pressure and insufficient autoregulation. This in turn may lead to unstable ocular perfusion and thereby to ischemia and reperfusion damage. This review discusses the potential role of OBF in glaucoma and how a disturbance of OBF could increase the optic nerve's sensitivity to IOP.
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            The nitric oxide-scavenging properties of Ginkgo biloba extract EGb 761.

            M Droy-Lefaix, L Marcocci, John Maguire … (1994)
            Ginkgo biloba extract EGb 761 was found to be a scavenger of nitric oxide in in vitro acellular systems, under physiological conditions. EGb 761 competed with oxyhemoglobin for reaction with nitric oxide generated during the interaction of hydroxylamine with Complex I of catalase. An EGb 761 dose-dependent decrease in the amount of nitrite formed in the reaction of oxygen with nitric oxide produced from solution of 5 mM sodium nitroprusside was also observed. These data implicate it as a potential therapeutic agent in conditions of altered production of nitric oxide.
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              Vasospasm, its role in the pathogenesis of diseases with particular reference to the eye.

              Josef Flammer, Mona Pache, Therese Resink (2001)
              Vasospasm can have many different causes and can occur in a variety of diseases, including infectious, autoimmune, and ophthalmic diseases, as well as in otherwise healthy subjects. We distinguish between the primary vasospastic syndrome and secondary vasospasm. The term "vasospastic syndrome" summarizes the symptoms of patients having such a diathesis as responding with spasm to stimuli like cold or emotional stress. Secondary vasospasm can occur in a number of autoimmune diseases, such as multiple sclerosis, lupus erythematosus, antiphospholipid syndrome, rheumatoid polyarthritis, giant cell arteritis, Behcet's disease, Buerger's disease and preeclampsia, and also in infectious diseases such as AIDS. Other potential causes for vasospasm are hemorrhages, homocysteinemia, head injury, acute intermittent porphyria, sickle cell disease, anorexia nervosa, Susac syndrome, mitochondriopathies, tumors, colitis ulcerosa, Crohn's disease, arteriosclerosis and drugs. Patients with primary vasospastic syndrome tend to suffer from cold hands, low blood pressure, and even migraine and silent myocardial ischemia. Valuable diagnostic tools for vasospastic diathesis are nailfold capillary microscopy and angiography, but probably the best indicator is an increased plasma level of endothelin-1. The eye is frequently involved in the vasospastic syndrome, and ocular manifestations of vasospasm include alteration of conjunctival vessels, corneal edema, retinal arterial and venous occlusions, choroidal ischemia, amaurosis fugax, AION, and glaucoma. Since the clinical impact of vascular dysregulation has only really been appreciated in the last few years, there has been little research in the according therapeutic field. The role of calcium channel blockers, magnesium, endothelin and glutamate antagonists, and gene therapy are discussed.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Korean J Ophthalmol
                Journal ID (publisher-id): KJO
                Title: Korean Journal of Ophthalmology : KJO
                Publisher: The Korean Ophthalmological Society
                ISSN (Print): 1011-8942
                ISSN (Electronic): 2092-9382
                Publication date (Print): October 2011
                Publication date (Electronic): 20 September 2011
                Volume: 25
                Issue: 5
                Pages: 323-328
                Affiliations
                [1 ]Department of Ophthalmology, NHIC Ilsan Hospital, Goyang, Korea.
                [2 ]The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.
                Author notes
                Reprint requests to Jong Woon Park, MD. Department of Ophthalmology, NHIC Ilsan Hospital, #100 Ilsan-ro, Ilsandong-gu, Goyang 410-719, Korea. Tel: 82-31-900-0220, Fax:82-31-900-0049, malgnnun@ 123456freechal.com
                Article
                DOI: 10.3341/kjo.2011.25.5.323
                PMC ID: 3178766
                PubMed ID: 21976939
                SO-VID: d7413e50-14cd-4a54-aaa5-800e8c2ff5aa
                Copyright © © 2011 The Korean Ophthalmological Society
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 19 January 2010
                Date accepted : 06 October 2010
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: heidelberg retina flowmeter,ginkgo biloba extract,normal tension glaucoma,ocular blood flow
                Data availability:
                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: heidelberg retina flowmeter, ginkgo biloba extract, normal tension glaucoma, ocular blood flow

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