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Annahita Amireskandari, Alon Harris, Brent A Siesky, George Eckert, Joshua Park, Ingrida Januleviciene, Darrell WuDunn; Retrobulbar and retinal capillary blood flow predict glaucomatous structural progression in patients with diabetes. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2922. doi: https://doi.org/.
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To examine the retrobulbar and retinal blood flow parameters and structural progression in patients with open-angle glaucoma (OAG) with and without diabetes (DM)
112 patients with OAG (21 with DM, 91 without DM) were assessed for retrobulbar blood flow in the ophthalmic (OA), central retinal (CRA), nasal (NPCA) and temporal (TPCA) posterior ciliary arteries as measured by color Doppler flowmetry and IOP using Goldmann applanation tonometry at baseline and every 6 months for a 4 year period. Disease progression was monitored with optical coherence tomography and Heidelberg retinal tomography and defined as two consecutive visits with RNFL thickness decrease by at least 8% and/or horizontal or vertical cup/disk ratio increase by at least 0.2 compared to baseline. Two-sample t-tests were used to test for differences in baseline data between patients who progressed and those who did not. A p-value <0.05 was considered statistically significant.
14 of the 21 patients with DM progressed with a mean baseline TPCA peak that was significantly lower than that of the diabetics who did not progress (p=0.0243). There were no significant differences in the TPCA PSV values of the non-diabetic patients who progressed and those who did not, resulting in a significant difference between patients with and without DM (p=0.0194). There were no significant differences in diabetics and non-diabetics that progressed and those that did not in regards to TPCA end diastolic velocity or resistive index or OA, CRA, or NPCA velocities or resistive indices (p>0.05). The number of superior zero blood flow pixels was significantly higher at baseline in patients with DM that progressed than in those that did not progress (p=0.0277). There were no significant differences in the number of superior zero blood flow pixels in patients without DM who progressed and those that did not, resulting in a significant difference between diabetics and non-diabetics (p=0.0024). There were no significant differences in superior mean flow, inferior zero blood flow pixels, inferior mean flow or IOP in either group (p<0.05).
In this cohort of patients with OAG, lower blood flow velocities in the vessels supplying the optic nerve head and lower retinal capillary flow at baseline were predictive of glaucomatous structural progression.
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