June 2013
Volume 54, Issue 15
Free
ARVO Annual Meeting Abstract  |   June 2013
Valsalva Maneuver, Intraocular Pressure, Cerebrospinal Fluid Pressure, and Optic Disc Topography: Beijing Intracranial and Intraocular Pressure (iCOP) Study
Author Affiliations & Notes
  • Ningli Wang
    Ophthalmology, Beijing Tongren Eye Center, Beijing, China
  • Zheng Zhang
    Ophthalmology, Beijing Tongren Eye Center, Beijing, China
  • Jost Jonas
    Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University Heidelberg, Mannheim, Germany
  • Robert Ritch
    Ophthalmology, the New York Medical College, New York, NY
  • Footnotes
    Commercial Relationships Ningli Wang, None; Zheng Zhang, National Natural Science Foundation of China (81271005) (F), Beijing Natural Science Foundation (7122038) (F), Award of Excellent Doctoral Dissertation of Beijing (Beijing YXBSGrant PXM2010_014226_07_000061 and PXM2011_014226_07_000114) (F), China Health and Medical Development Foundation (F); Jost Jonas, Allergan (C), MSD (C), Alimera (C), CellMed AG (P); Robert Ritch, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 63. doi:
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      Ningli Wang, Zheng Zhang, Jost Jonas, Robert Ritch, ; Valsalva Maneuver, Intraocular Pressure, Cerebrospinal Fluid Pressure, and Optic Disc Topography: Beijing Intracranial and Intraocular Pressure (iCOP) Study. Invest. Ophthalmol. Vis. Sci. 2013;54(15):63.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: To assess whether a Valsalva maneuver influences intraocular pressure (IOP), cerebrospinal fluid pressure (CSF-P) and, by a change in the trans-laminar cribrosa pressure difference, optic nerve head morphology.

Methods: The study included 20 neurological patients who required lumbar puncture and 20 healthy volunteers. In a first study part, neurological patients underwent measurement of IOP and lumbar CSF-P measurement in a lying position before and during a Valsalva maneuver with a documented continuous expiratory pressure of ≥30 mmHg for about 20 seconds. In the second part, 20 healthy subjects underwent ocular tonometry and confocal scanning laser tomography of the optic nerve head before and during a Valsalva maneuver.

Results: During the Valsalva maneuver in the first study part, the increase in CSF-P by 10.5±2.7 mmHg was significantly (P<0.001) higher than the increase in IOP by 1.9±2.4 mmHg. The change in CSF-P was not significantly (P=0.61) correlated with the change in IOP. During the Valsalva maneuver in the second part, IOP increased by 4.5±4.2 mmHg and optic cup volume (P<0.001), cup/disc area ratio (P=0.04), cup/disc diameter ratio (P=0.03) and maximum optic cup depth (P=0.02) significantly decreased, while neuroretinal rim volume (P=0.003) and mean retinal nerve fiber layer thickness (P=0.02) significantly increased.

Conclusions: The Valsalva maneuver-associated increase in CSF-P was significantly larger than, and not correlated with, and a simultaneous increase in IOP. This Valsalva maneuver associated reversal of the trans-lamina cribrosa pressure difference resulted in a change of the three-dimensional optic nerve head morphology with a decrease in optic cup related parameters and an enlargement of neuroretinal rim related parameters. These findings may be relevant to the pathogenesis of glaucomatous optic neuropathy.

Keywords: 627 optic disc • 550 imaging/image analysis: clinical • 577 lamina cribrosa  
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