Journal List > J Korean Ophthalmol Soc > v.57(8) > 1010368

TOOLS
Cheong, Han, and Choi: Correlation between Trans-lamina Cribrosa Pressure Difference and Morphologic Parameters of Optic Disc in Normal Tension Glaucoma Patients
Original Article

J Korean Ophthalmol Soc 2016;57(8):1260-1267.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.8.1260

Correlation between Trans-lamina Cribrosa Pressure Difference and Morphologic Parameters of Optic Disc in Normal Tension Glaucoma Patients

Yu Jin Cheong, MD, Kyung Eun Han, MD, Kyu Ryong Choi, MD, PhD

Department of Ophthalmology, Ewha Institute of Ophthalmology and Optometry, Ewha Womans University School of Medicine, Seoul, Korea

Address reprint requests to Kyu Ryong Choi, MD, PhD Department of Ophthalmology, Ewha Womans University Mokdong Hospital, #1071 Anyangcheon-ro, Yangcheon-gu, Seoul 07985, Korea Tel: 82-2-2650-5154, Fax: 82-2-2650-4334 E-mail: ckrey02@ewha.ac.kr

Received 21 April 2016       Revised 23 May 2016       Accepted 25 July 2016

Copyright © 2016 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 the relationship between trans-lamina cribrosa pressure difference (TLCPD) and morphologic parameters of optic disc (OD) in normal tension glaucoma (NTG) patients.

Methods

Data from 31 NTG patients (31 eyes) and 29 controls (29 eyes) were analyzed retrospectively. Their cerebrospinal fluid pressure was estimated using diastolic pressure (DBP), body mass index (BMI) and age. TLCPD was defined as the difference of intraocular pressure (IOP) and the estimated cerebrospinal fluid pressure (ECSFP). Measurements of the rim area (RA), disc area (DA), average and vertical cup/disc (C/D) ratio, retinal nerve fiber layer thickness (RNFLT) and cup volume (CV) were taken for all patients using optical coherence tomography. The correlation between TLCPD and morphologic parameters of OD were assessed.

Results

There were no significant differences between the two groups in terms of age, DBP, IOP and spherical equivalent
(SE) and BMI. The mean ECSFP was significantly higher in the controls (10.7 ± 2.8 vs. 12.2 ± 2.2 mm Hg, p = 0.031) and TLCPD was significantly higher in patients (2.4 ± 2.1 vs. 4.9 ± 3.7 mm Hg, p = 0.002). In the NTG group, there was a negative correlation between TLCPD and RA (r = −0.595) and positive correlations between TLCPD and the average C/D ratio (r = 0.504), vertical C/D ratio (r = 0.434) and CV (r = 0.420). Average RNLFT was also significantly correlated with TLCPD (r = −0.500) and RNFLT for four quadrants, except the nasal quadrant, in NTG patients.

Conclusions

NTG patients had higher TLCPD. A higher TLCPD was associated with a narrower RA, larger C/D ratio, and thinner RNFLT.

Keywords: Estimated cerebrospinal fluid pressure, Normal tension glaucoma, Optical coherence tomography, Rim area, Trans-lamina cribrosa pressure difference

References

1. Berdahl JP, Allingham RR, Johnson DH. Cerebrospinal fluid abdominal is decreased in primary open-angle glaucoma. Ophthalmology. 2008; 115:763–8.
2. Jonas JB, Berenshtein E, Holbach L. Anatomic relationship abdominal lamina cribrosa, intraocular space, and cerebrospinal fluid space. Invest Ophthalmol Vis Sci. 2003; 44:5189–95.
3. Xie X, Zhang X, Fu J, et al. Noninvasive intracranial pressure abdominal by orbital subarachnoid space measurement: the Beijing Intracranial and Intraocular Pressure (iCOP) study. Crit Care. 2013; 17:R162.
4. Jonas JB, Wang N, Wang YX, et al. Body height, estimated abdominal fluid pressure and open-angle glaucoma. The Beijing Eye Study 2011. PLoS One. 2014; 9:e86678.
5. Garvin MK, Abràmoff MD, Wu X, et el. Automated 3-D abdominal layer segmentation of macular spectraldomain optical abdominal tomography images. IEEE Trans Med Imaging. 2009; 28:1436–47.
6. Shpak AA, Sevostyanova MK, Ogorodnikova SN, Shormaz IN. Comparison of measurement error of Cirrus HD-OCT and Heidelberg Retina Tomograph 3 in patients with early abdominal visual field defect. Graefes Arch Clin Exp Ophthalmol. 2012; 250:271–7.
7. Sommer A, Katz J, Quigley HA, et al. Clinically detectable nerve fiber atrophy precedes the onset of glaucomatous field loss. Arch Ophthalmol. 1991; 109:77–83.
crossref
8. Kim CS, Seong GJ, Lee NH, et al. Prevalence of primary open-angle glaucoma in central South Korea the Namil study. Ophthalmology. 2011; 118:1024–30.
9. Leske MC, Wu SY, Hennis A, et al. Risk factors for incident open-angle glaucoma: the Barbados Eye Studies. Ophthalmology. 2008; 115:85–93.
10. Ren R, Wang N, Zhang X, et al. Trans-lamina cribrosa pressure abdominal correlated with neuroretinal rim area in glaucoma. Graefes Arch Clin Exp Ophthalmol. 2011; 249:1057–63.
11. Jonas JB, Gründler AE, Gonzales-Cortés J. Pressure-dependent abdominal rim loss in normal-pressure glaucoma. Am J Ophthalmol. 1998; 125:137–44.
12. Morgan WH, Yu DY, Cooper RL, et al. The influence of abdominal fluid pressure on the lamina cribrosa tissue pressure gradient. Invest Ophthalmol Vis Sci. 1995; 36:1163–72.
13. Berdahl JP, Fautsch MP, Stinnett SS, Allingham RR. Intracranial pressure in primary open angle glaucoma, normal tension glaucoma, and ocular hypertension: a case-control study. Invest Ophthalmol Vis Sci. 2008; 49:5412–8.
crossref
14. Ren R, Jonas JB, Tian G, et al. Cerebrospinal fluid pressure in abdominal: a prospective study. Ophthalmology. 2010; 117:259–66.
15. Jonas JB, Nangia V, Wang N, et al. Trans-lamina cribrosa pressure difference and open-angle glaucoma. The central India eye and medical study. PLoS One. 2013; 8:e82284.
crossref

Figure 1.
The relationship between trans lamina cribrosa pressure difference (TLCPD) and rim area in normal tension glaucoma patients. r = Pearson's correlation coefficient. * p-value by Pearson's correlation analysis.
jkos-57-1260f1.tif
Figure 2.
The relationship between trans lamina cribrosa pressure difference (TLCPD) and cup/disc (C/D) ratio in normal tension glaucoma patients. r = Pearson's correlation coefficient. * p-value by Pearson's correlation analysis.
jkos-57-1260f2.tif
Figure 3.
The relationship between trans lamina cribrosa pressure difference (TLCPD) and average retinal nerve fiber layer (RNFL) thickness in normal tension glaucoma patients. r = Pearson's correlation coefficient. * p-value by Pearson's correlation analysis
jkos-57-1260f3.tif
Figure 4.
The relationship between trans lamina cribrosa pressure difference (TLCPD) and average retinal nerve fiber layer (RNFL) thicknesses of 4 quadrant in normal tension glaucoma * p-value by patients. r = Pearson's correlation coefficient. pearson's correlation analysis.
jkos-57-1260f4.tif
Table 1.
Clinical and ophthalmic characteristics of control and normal tension glaucoma (NTG) patient group
  Control NTG patients p-value
Age (years) 50.14 ± 11.62 53.10 ± 9.28 0.279*
Sex (n, %)     0.782†
 Male 13 (45.8) 15 (48.4)  
 Female 16 (55.2) 16 (51.6)  
BMI (kg/m2) 24.42 ± 2.93 22.28 ± 3.27 0.100*
DBP (mm Hg) 77.24 ± 6.95 77.42 ± 9.78 0.936*
ECSFP (mm Hg) 12.18 ± 2.20 10.73 ± 2.79 0.031*
TLCPG (mm Hg) 2.37 ± 2.14 4.94 ± 3.71 0.002*
IOP (mm Hg) 14.55 ± 2.64 15.68 ± 2.47 0.093*
SE (diopter) –0.90 ± 1.77 –1.87 ± 2.01 0.051*
Rim area (μ m2) 1.33 ± 0.18 0.84 ± 0.19 <0.001*
Disc area (μ m2) 2.04 ± 0.45 1.99 ± 0.39 0.639*
Average C/D ratio 0.56 ± 0.13 0.75 ± 0.07 <0.001*
Vertical C/D ratio 0.52 ± 0.13 0.73 ± 0.08 <0.001*
Average RNFLT (μ m) 98.83 ± 8.60 77.61 ± 14.67 <0.001*
Nasal RNFLT (μ m) 68.10 ± 9.86 62.29 ± 11.07 0.037*
Temporal RNFLT (μ m) 77.76 ± 12.75 57.68 ± 12.30 <0.001*
Superior RNFLT (μ m) 120.90 ± 14.67 90.07 ± 24.61 <0.001*
Inferior RNFLT (μ m) 127.10 ± 14.25 100.65 ± 23.32 <0.001*
Cup volume (μ m3) 0.24 ± 0.18 0.58 ± 0.36 <0.001*

Values are presented as mean ± SD unless otherwise indicated.

BMI = body mass index; DBP = diastolic blood pressure; ECSFP = estimated cerebrospinal fluid pressure; TLCPG = trans lamina cribros pressure gradient; IOP = intraocular pressure; SE = spherical equivalent; C/D = cup/disc; RNFLT = retinal nerve fiber layer thickness.

* Independent samples t-test

† Chi-square test.

Table 2.
Associations between rim area, disc area, average and vertical cup/disc (C/D) ratio, retinal nerve fiber layer thickness (RNFLT), cup volume, IOP, TLCPD and ECSFP in NTG patient group
    r p-value*
Rim area correlated with IOP –0.317 0.082
  ECSFP 0.511 0.003
  TLCPD –0.595 <0.001
Disc area correlated with IOP 0.278 0.131
  ECSFP 0.119 0.523
  TLCPD 0.095 0.611
Average C/D ratio correlated with IOP 0.406 0.024
  ECSFP –0.312 0.087
  TLCPD 0.504 0.004
Vertical C/D ratio correlated with IOP 0.243 0.188
  ECSFP –0.363 0.045
  TLCPD 0.434 0.015
Average RNFLT (μ m) correlated with IOP –0.141 0.450
  ECSFP 0.540 0.002
  TLCPD –0.500 0.004
Inferior RNFLT (μ m) correlated with IOP –0.162 0.384
  ECSFP 0.489 0.005
  TLCPD –0.475 0.007
Superior RNFLT (μ m) correlated with IOP –0.142 0.445
  ECSFP 0.420 0.019
  TLCPD –0.410 0.022
Nasal RNFLT (μ m) correlated with IOP –0.104 0.578
  ECSFP 0.247 0.181
  TLCPD –0.255 0.167
Temporal RNFLT (μ m) correlated with IOP –0.002 0.990
  ECSFP 0.555 0.001
  TLCPD –0.417 0.020
Cup volume (mm3) correlated with IOP 0.371 0.040
  ECSFP –0.230 0.213
  TLCPD 0.420 0.019

IOP = intraocular pressure; TLCPD = trans lamina cribrosa pressure difference; ECSFP = estimated cerebrospinal fluid pressure; NTG = normal tension glaucoma; r = Pearson's correlation coefficient.

* p-value by Pearson's correlation analysis.

Table 3.
Associations between rim area, disc area, average and vertical cup/disc (C/D) ratio, retinal nerve fiber layer thickness (RNFLT) thickness, cup volume, intraocular pressure (IOP), trans lamina cribrosa pressure difference (TLCPD) and estimated cerebrospinal fluid pressure (ECSFP) in control group
    r p-value*
Rim area correlated with IOP 0.004 0.982
  ECSFP 0.133 0.492
  TLCPD –0.131 0.497
Disc area correlated with IOP –0.119 0.539
  ECSFP –0.422 0.023
  TLCPD 0.288 0.130
Average C/D ratio correlated with IOP –0.102 0.600
  ECSFP –0.380 0.042
  TLCPD 0.267 0.162
Vertical C/D ratio correlated with IOP –0.010 0.957
  ECSFP –0.245 0.200
  TLCPD 0.240 0.210
Average RNFLT (μ m) correlated with IOP 0.107 0.582
  ECSFP 0.174 0.367
  TLCPD –0.048 0.807
Inferior RNFLT (μ m) correlated with IOP 0.256 0.181
  ECSFP 0.444 0.016
  TLCPD –0.142 0.463
Superior RNFLT (μ m) correlated with IOP –0.054 0.782
  ECSFP 0.093 0.632
  TLCPD –0.162 0.401
Nasal RNFLT (μ m) correlated with IOP 0.005 0.981
  ECSFP –0.285 0.134
  TLCPD 0.299 0.115
Temporal RNFLT (μ m) correlated with IOP 0.072 0.710
  ECSFP 0.130 0.500
  TLCPD –0.046 0.814
Cup volume (mm3) correlated with IOP –0.001 0.997
  ECSFP –0.380 0.042
  TLCPD 0.391 0.036

r = Pearson's correlation coefficient.

* p-value by pearson's correlation analysis.

TOOLS
Similar articles