October 2015
Volume 56, Issue 11
Free
Letters to the Editor  |   October 2015
Glaucoma and the Role of Cerebrospinal Fluid Dynamics
Author Affiliations & Notes
  • Zheng Zhang
    Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China;
    Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China;
  • Danli Liu
    The State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China;
  • Jost B. Jonas
    Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China;
    Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University Heidelberg, Seegartenklinik Heidelberg, Germany; and
  • Shen Wu
    Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China;
    Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China;
  • Jacky M. K. Kwong
    Jules Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States.
  • Jingxue Zhang
    Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China;
    Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China;
  • Qian Liu
    Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China;
  • Lei Li
    Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China;
  • Qingjun Lu
    Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China;
    Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China;
  • Diya Yang
    Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China;
  • Jinda Wang
    Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China;
  • Ningli Wang
    Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China;
    Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China;
Investigative Ophthalmology & Visual Science October 2015, Vol.56, 6632. doi:10.1167/iovs.15-18145
  • Views
  • PDF
  • Share
  • Tools
    • Alerts
      ×
      This feature is available to Subscribers Only
      Sign In or Create an Account ×
    • Get Citation

      Zheng Zhang, Danli Liu, Jost B. Jonas, Shen Wu, Jacky M. K. Kwong, Jingxue Zhang, Qian Liu, Lei Li, Qingjun Lu, Diya Yang, Jinda Wang, Ningli Wang; Glaucoma and the Role of Cerebrospinal Fluid Dynamics. Invest. Ophthalmol. Vis. Sci. 2015;56(11):6632. doi: 10.1167/iovs.15-18145.

      Download citation file:


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

      ×
  • Supplements
The authors thank Wostyn and colleagues1 for their letter and their interest in our study.2 Wostyn and colleagues mentioned studies on normal-tension glaucoma (NTG) patients who showed a reduction in cerebrospinal fluid pressure (CSFP),36 and proposed that the lower CSFP reported in NTG patients could be an indicator of CSF circulatory failure, which could ultimately result in reduced clearance of toxic substances in the subarachnoid space surrounding the optic nerve and lead to glaucomatous damage.1 
According to our study, short-term lowering of CSFP is associated with an impediment in both the orthograde axoplasmic flow and the retrograde axonal transport in the retinal ganglion cell axons,2,7 which partially supports this hypothesis. In addition, Jaggi and colleagues8 demonstrated in a previous study the CSF circulatory failure in the optic nerve by blocking the subarachnoid space could lead to severe nerve damage. This CSF circulatory dysfunction has also been found in subjects with NTG through computed tomography cisternography of the brain and orbits.9 
However, the results of our study showed that the retinal layers, including the retinal ganglion cell layer, appeared grossly intact in the low-CSFP study group.2,7 Wostyn and colleagues1 further speculated that CSF aspiration during the study period could reduce the CSF outflow resistance and may improve CSF turnover, which could provide a protective effect against glaucomatous damage due to enhanced removal of potentially neurotoxic waste products that would accumulate in the optic nerve. This hypothesis could potentially explain the absence of retinal ganglion cell loss in the low-CSFP rat model. The authors fully agree with their notion, and it may imply that both the hydrostatic pressure and the dynamics of CSF may be of potentially high importance for the physiological stability of the optic nerve. 
References
Wostyn P, De Groot V, Van Dam D, Audenaert K, Killer HE, De Deyn PP. Glaucoma and the role of cerebrospinal fluid dynamics. Invest Ophthalmol Vis Sci. 2015; 56: 6630–6631.
Zhang Z, Liu D, Jonas JB, et al. Axonal transport in the rat optic nerve following short-term reduction in cerebrospinal fluid pressure or elevation in intraocular pressure. Invest Ophthalmol Vis Sci. 2015; 56: 4257–4266.
Berdahl JP, Allingham RR, Johnson DH. Cerebrospinal fluid pressure is decreased in primary open-angle glaucoma. Ophthalmology. 2008; 115: 763–768.
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: 5412–5418.
Ren R, Jonas JB, Tian G, et al. Cerebrospinal fluid pressure in glaucoma: a prospective study. Ophthalmology. 2010; 117: 259–266.
Wang N, Xie X, Yang D, et al. Orbital cerebrospinal fluid space in glaucoma: the Beijing intracranial and intraocular pressure (iCOP) study. Ophthalmology. 2012; 119: 2065–2073.e1.
Zhang Z, Wu S, Jonas JB, et al. Dynein, kinesin and morphological changes in optic nerve axons in a rat model with cerebrospinal fluid pressure reduction: the Beijing Intracranial and Intraocular Pressure (iCOP) study [ published online ahead of print July 14, 2015]. Acta Ophthalmol. doi:10.1111/aos.12768.
Jaggi GP, Harlev M, Ziegler U, Dotan S, Miller NR, Killer HE. Cerebrospinal fluid segregation optic neuropathy: an experimental model and a hypothesis. Br J Ophthalmol. 2010; 94: 1088–1093.
Killer HE, Miller NR, Flammer J, et al. Cerebrospinal fluid exchange in the optic nerve in normal-tension glaucoma. Br J Ophthalmol. 2012; 96: 544–548.
×
×

This PDF is available to Subscribers Only

Sign in or purchase a subscription to access this content. ×

You must be signed into an individual account to use this feature.

×