Cerebrospinal Fluid Pressure in Glaucoma: A Prospective Study

• Published in: Ophthalmology (Rochester, Minn.) Vol. 117; no. 2; pp. 259 - 266
• Main Authors: RUOJIN REN, JONAS, Jost B, GUOGHONG TIAN, YI ZHEN, KE MA, SHUNING LI, HONGTAO WHANG, BIN LI, XIAOJUN ZHANG, NINGLI WANG
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier 01.02.2010
• Subjects: Adult; Biological and medical sciences; Blood Pressure - physiology; Cerebrospinal Fluid Pressure - physiology; Female; Glaucoma and intraocular pressure; Glaucoma, Open-Angle - etiology; Glaucoma, Open-Angle - physiopathology; Humans; Intracranial Hypotension - physiopathology; Intraocular Pressure - physiology; Male; Medical sciences; Middle Aged; Miscellaneous; Ophthalmology; Optic Nerve Diseases - etiology; Optic Nerve Diseases - physiopathology; Prospective Studies; Spinal Puncture; Visual Fields - physiology; Glaucoma; Prospective; Protozoa; Eye disease; Glaucoma (eye); Ciliata; Cerebrospinal fluid; Ophthalmology; Pressure
• ISSN: 0161-6420; 1549-4713; 1549-4713
• DOI: 10.1016/j.ophtha.2009.06.058

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.