J Korean Ophthalmol Soc.  2013 Sep;54(9):1386-1394.

Relationship Between Nocturnal Dip, Carotid Artery Blood Flow, Brain Ischemic Change in Open Angle Glaucoma

Affiliations
  • 1Department of Ophthalmology, Dong-A University Medical Center, Dong-A University College of Medicine, Busan, Korea. shrho@donga.ac.kr

Abstract

PURPOSE
To investigate the effect of nocturnal dip, carotid artery blood flow, and brain ischemic change on the progression of glaucomatous visual field defect in open-angle glaucoma (OAG) when IOP is less than the target pressure.
METHODS
We classified OAG patients (74 patients, 148 eyes) who maintained IOP less than the target pressure as normal tension glaucoma (NTG; 52 patients, 104 eyes) or primary OAG (POAG; 22 patients, 44 eyes). Additionally, we performed 24-hr ambulatory blood pressure monitoring (24-hr ABPM), carotid artery color Doppler U/S (CAD), brain MRI, and visual field (V/F) tests on the patients. Nocturnal dips less than 10% were classified as non-dippers, and dips greater than 10% as dippers. The relationships among nocturnal dip, carotid artery blood flow, brain ischemic change, and progression of glaucomatous V/F defect were examined.
RESULTS
In the case of dippers, glaucomatous V/F defects were aggravated, with a relative risk of approximately 1.74 (NTG) and 2.91 (POAG) times that of non-dippers. In NTG, decreased carotid artery blood flow and brain ischemic change furthered glaucomatous V/F defects, with a relative risk of approximately 2.40 and 2.54 times that of normal carotid artery blood flow and brain MRI findings, respectively. However, in POAG, decreased carotid artery blood flow and brain ischemic change were not influenced by the progression of glaucomatous V/F defects.
CONCLUSIONS
In dippers, decreased carotid artery blood flow and brain ischemic change caused a progression of glaucomatous V/F defects in NTG and POAG patients. Thus, performing 24-hr ABPM, CAD, and brain MRI should be helpful for glaucoma patients with progression of glaucomatous V/F defects even when the IOP is less than the target pressure. In addition, this analysis provides useful information regarding glaucoma diagnosis and treatment.

Keyword

Brain ischemia; Carotid artery blood flow; Dipper; Progression of visual field defect; 24-hour blood pressure monitoring

MeSH Terms

Blood Pressure Monitoring, Ambulatory
Brain
Brain Ischemia
Carotid Arteries
Glaucoma
Glaucoma, Open-Angle
Humans
Low Tension Glaucoma
Salicylates
Visual Fields
Salicylates

Figure

  • Figure 1. Abnormal findings of CAD. (A) Increased intima-media thickness in left common carotid artery (white arrow). (B) Multiple atheromas in left internal carotid artery (white arrows).

  • Figure 2. Abnormal findings of brain MRI. (A) Chronic ischemic change deep white matter, basal ganglia. (B) Brain atrophy. widening of the sulci, thinning of the corpus callosum, enlargement of the lateral ventricles.


Reference

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