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Park, Park, Yoon, and Park: Diurnal Fluctuation of Ocular Perfusion Pressure in the Fellow Eyes of Branch Retinal Vein Occlusion
Original Article

J Korean Ophthalmol Soc 2014;55(2):237-246.

Published online: 7 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.2.237

Diurnal Fluctuation of Ocular Perfusion Pressure in the Fellow Eyes of Branch Retinal Vein Occlusion

Chang Hyun Park, MD1, Hae Young Park, MD1, Jae Yoon Yoon, MD2, Chan Kee Park, MD, PhD1

1Department of Ophthalmology and Visual Science, Seoul St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea

2Department of Ophthalmology, Saevit Eye Hospital, Goyang, Korea

Address reprint requests to Chan Kee Park, MD, PhD Department of Ophthalmology, The Catholic University of Korea Seoul St. Mary’s Hospital, #222 Banpo-daero, Seocho-gu, Seoul 137-701, Korea, Tel: 82-2-2258-1188, Fax: 82-2-599-7405, E-mail: ckpark@catholic.ac.kr

Received 19 July 20134 August 2013       Accepted 7 December 2013

Copyright © 2014 Korean Ophthalmological Society

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.

Abstract

Purpose

To investigate diurnal change in blood pressure (BP), intraocular pressure (IOP), and ocular perfusion pressure (OPP) in patients with unilateral branch retinal vein occlusion (BRVO) and compare the results with healthy controls.

Methods

We conducted a prospective case‐ control study which included 50 patients with unilateral BRVO and 50 age‐ matched volunteers as controls. Each participant underwent a comprehensive ophthalmic examination including optical coherence tomography (OCT). BP and IOP were evaluated 4 times daily at 8 AM, 10 AM, 2 PM and 6 PM. The mean and fluctuation of BP, IOP, mean arterial pressure (MAP), mean OPP (MOPP), and diastolic OPP (DOPP) were compared between fellow eyes of BRVO patients and normal control eyes.

Results

The average retinal nerve fiber layer (RNFL) thickness was significantly reduced in the fellow eyes of BRVO patients compared to control eyes (p < 0.001). Mean IOP and IOP fluctuation did not differ, but BP fluctuation (systolic BP fluctuation, p = 0.045; diastolic BP fluctuation, p = 0.037) and MAP fluctuation (p = 0.011) were greater in the fellow eyes of BRVO patients compared to normal eyes. The mean MOPP and DOPP did not differ between groups, however, the fluctuation of MOPP (p < 0.001) and DOPP (p < 0.001) were significantly increased in the fellow eyes of BRVO patients. The mean and fluctuation of BP, MAP, MOPP and DOPP were associated with reduced average RNFL thickness in the fellow eyes of BRVO patients.

Conclusions

These results suggest the fellow eyes of unilateral BRVO patients may be at risk of developing glaucomatous damage.

Keywords: Branch retinal vein occlusion, Diurnal fluctuation, Glaucoma, Ocular perfusion pressure

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Figure 1.
Comparison of optical coherence tomography clock- hour retinal nerve fiber layer (RNFL) thickness profiles between healthy eyes, branched retinal vein occlusion eyes, and unaffected fellow eyes.
jkos-55-237f1.tif
Figure 2.
Fluctuation of intraocular pressure (IOP) and ocular perfusion pressure (OPP) in healthy control eyes and fellow eyes of unilateral branched retinal vein occlusion. The mean diurnal variation of IOP, mean OPP (MOPP) and mean diastolic OPP (DOPP) at different time points are shown (left column). The mean IOP, MOPP, and DOPP shows no significant difference at any time point between groups. The absolute diurnal changes of MOPP and DOPP shows significant difference (*) between the control eyes versus fellow eyes (right column).
jkos-55-237f2.tif
Figure 3.
Representative case 1: 52-year-old man with branched retinal vein occlusion (BRVO) in the left eye. Larger diurnal MOPP, and DOPP fluctuation are observed in the fellow eye of the patient, compared to the mean of control eyes. The localized retinal nerve fiber layer (RNFL) defect is found in the superotemporal area in the fellow eye and superotemporal RNFL is reduced on OCT measurements.
jkos-55-237f3.tif
Table 1.
Mean retinal nerve fiber layer thickness measured by optical coherence tomography
  Control Fellow eyes BRVO eyes p-value* p-value† p-value‡
Average 110.52 ± 10.45 92.78 ± 13.35 69.79 ± 13.10 <0.001 <0.001 <0.001
Quadrant            
  Temporal 76.05 ± 10.79 70.73 ± 8.81 62.25 ± 8.93 0.033 0.004 0.665
  Superior 125.52 ± 11.84 111.06 ± 20.68 89.32 ± 18.47 0.011 <0.001 <0.001
  Nasal 75.06 ± 7.77 74.49 ± 11.24 64.87 ± 8.74 0.257 0.024 0.152
  Inferior 127.47 ± 11.41 111.83 ± 12.67 103.72 ± 16.26 <0.001 <0.001 0.193
Clock hours            
  1 125.77 ± 17.39 119.50 ± 26.37 99.31 ± 28.07 0.013 <0.001 <0.001
  2 87.45 ± 19.30 81.30 ± 15.85 74.18 ± 16.83 0.378 0.214 0.360
  3 63.45 ± 7.81 60.20 ± 7.34 55.48 ± 10.11 0.455 0.489 0.532
  4 70.99 ± 14.19 68.09 ± 9.13 57.67 ± 7.29 0.314 0.303 0.157
  5 139.67 ± 21.75 120.45 ± 21.81 94.35 ± 20.11 <0.001 <0.001 <0.001
  6 140.13 ± 22.57 131.74 ± 27.89 118.32 ± 27.42 0.040 <0.001 0.017
  7 112.03 ± 17.44 95.56 ± 15.31 86.89 ± 14.73 <0.001 <0.001 0.164
  8 77.06 ± 11.06 73.60 ± 12.90 62.12 ± 8.48 0.212 0.004 0.054
  9 70.83 ± 10.04 62.35 ± 9.92 59.48 ± 10.02 0.236 0.017 0.608
  10 84.31 ± 14.13 80.55 ± 17.90 73.49 ± 14.61 0.172 0.048 0.366
  11 110.59 ± 19.00 102.61 ± 30.09 84.34 ± 19.88 0.147 <0.001 <0.001
  12 130.66 ± 20.05 118.43 ± 27.04 84.78 ± 23.11 <0.001 <0.001 <0.001

Values are presented as mean ± SD.

BRVO = branch retinal vein occlusion.

* Comparison between control and fellow eyes

† Comparison between control and BRVO eyes

‡ Comparison between fellow and BRVO eyes.

Table 2.
Systemic and ocular measurements
  Normal controls BRVO patients p-value
Number 50 50  
Age (years) 63.63 ± 6.54 64.84 ± 5.67 0.721†
Sex (male:female) 28:22 26:24 0.665‡
Spherical equivalent (diopters)* -0.63 ± 1.11 -0.54 ± 1.27 0.713†
Intraocular pressure (mm Hg)*      
  Mean 14.35 ± 2.33 14.54 ± 2.35 0.990†
  Peak 15.50 ± 2.39 16.27 ± 2.16 0.146†
  Fluctuation 1.59 ± 0.85 2.07 ± 0.96 0.112†
Visual field exam (dB)*      
  Mean deviation -0.64 ± 2.46 -1.47 ± 1.26 0.255†
  Pattern standard deviation 1.57 ± 2.14 1.94 ± 1.04 0.131†
Systemic hypertension (n) 10 (20.0%) 30 (60.0%) <0.001‡
  Taking antihypertensive medication 8 (80.0%) 25 (83.3%) 0.831‡
Systolic BP (mm Hg)      
  Mean 125.93 ± 12.66 136.48 ± 12.19 0.164
  Fluctuation 18.8 ± 3.55 25.67 ± 3.53 0.045
Diastolic BP (mm Hg)      
  Mean 73.43 ± 11.94 80.60 ± 22.68 0.201
  Fluctuation 19.0 ± 5.04 27.23 ± 4.86 0.037
Mean arterial pressure (mm Hg)      
  Mean 92.26 ± 9.82 92.56 ± 10.35 0.535
  Fluctuation 10.22 ± 7.03 19.89 ± 9.85 0.011

Values are presented as mean ± SD.

BRVO = branch retinal vein occlusion; BP = blood pressure.

* Values are for the unaffected fellow eyes in the RVO patients

† By independent t-test

‡ By chi-square test.

Table 3.
Measurements in intraocular pressure and ocular perfusion pressure
  Control eyes Fellow eyes p-value*
Ocular perfusion pressure      
  Mean 47.16 ± 2.72 47.05 ± 2.08 0.791
  Fluctuation 10.27 ± 2.31 17.71 ± 3.32 <0.001
Diastolic ocular perfusion pressure      
  Mean 36.60 ± 2.85 35.45 ± 2.15 0.573
  Fluctuation 10.01 ± 3.18 18.13 ± 3.36 <0.001

Values are presented as mean ± SD.

* By independent t-test.

Table 4.
Significance of independent variables in predicting outcomes of retinal nerve fiber layer thickness in the fellow eyes of unilateral BRVO by univariate models
Variable Beta [95% CI] p-value
Age 1.012 [0.721-4.433] 0.601
SE 0.934 [0.315-1.216] 0.522
History of systemic hypertension 1.167 [0.916-5.973] 0.048*
Systemic antihypertensive medication 1.033 [0.840-5.723] 0.379
VF MD 1.046 [0.753-3.816] 0.462
VF PSD 1.058 [0.801-3.573] 0.411
Mean IOP 1.121 [1.014-4.168] 0.130
Peak IOP 1.008 [0.912-3.410] 0.286
IOP fluctuation 1.104 [0.830-3.533] 0.187
Mean SBP 0.572 [0.313-0.914] 0.518
SBP fluctuation 1.032 [0.852-4.260] 0.386
Mean DBP 1.040 [0.971-1.114] 0.247
DBP fluctuation 1.173 [1.015-2.016] 0.016*
Mean MAP 0.928 [0.716-1.097] 0.540
MAP fluctuation 1.043 [0.917-1.180] 0.382
MOPP 1.044 [0.985-1.116] 0.251
MOPP fluctuation 1.028 [0.999-2.005] 0.256
Mean DOPP 1.128 [1.087-2.025] 0.200
DOPP fluctuation 0.163 [1.121-2.309] 0.009*

BRVO = branched retinal vein occlusion; SE = spherical equivalent; VF = visual field; MD = mean deviation; PSD = pattern standard deviation; IOP = intraocular pressure; SBP = systolic blood pressure; DBP = diastolic blood pressure; MAP = mean arterial pressure; MOPP = mean ocular perfusion pressure; DOPP = diastolic ocular perfusion pressure.

* p < 0.05.

Table 5.
Significance of independent variables in predicting outcomes of retinal nerve fiber layer thickness in the fellow eyes of unilateral BRVO by multivariate models
Variable Beta [95% CI] p-value
Age 1.008 [0.578-3.267] 0.720
SE 0.819 [0.310-1.082] 0.618
History of systemic hypertension 1.964 [0.893-4.510] 0.097
Systemic antihypertensive medication 0.617 [0.127-1.815] 0.446
DOPP fluctuation 1.911 [1.184-4.630] 0.005*

BRVO = branch retinal vein occlusion; SE = spherical equivalent; DOPP = diastolic ocular perfusion pressure.

* p < 0.05.

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