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Yochai Z. Shoshani, Alon Harris, Kay D. Rittenhouse, Brent A. Siesky, Mohammadali M. Shoja, Yoel Arieli, Barbara M. Wirostko, Christian Jonescu, Rita Ehrlich, George Eckert; Decreasing Retrobulbar Blood Flow is Predictive of OCT Structural Changes in Patients with Primary Open Angle Glaucoma. Invest. Ophthalmol. Vis. Sci. 2011;52(14):3478.
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To examine the association between retrobulbar blood flow and retinal nerve fiber layer (RNFL) thickness and optic nerve head (ONH) structure in patients with primary open angle glaucoma (OAG).
Changes in retrobulbar blood flow were examined in relation to changes in ONH structure and RNFL thickness after 18 months in 103 patients (age 67.0, 60 females) with OAG participating in the Indianapolis Glaucoma Progression Study (IGPS). Retrobulbar blood flow was assessed by color Doppler imaging (CDI) in the temporal (TPCA) and nasal (NPCA) short posterior ciliary arteries, ophthalmic artery (OA), and central retinal artery (CRA) measuring peak systolic (PSV) and end diastolic (EDV) blood flow velocities and vascular resistance (RI). RNFL thickness and ONH parameters were assessed with optical coherence tomography (OCT). Multivariable linear regression models were analyzed for the change from baseline for each measurement.
When compared to baseline, there was a statistically significant deterioration of horizontal integrated rim width (p=0.0002), cup area (0.0038), rim area (p=0.0037) and cup/disk vertical ratio (<0.001) after 18 months follow up. The bivariate analysis revealed a negative correlation between the TPCA RI at 18 months and the change in horizontal integrated rim width (r=-0.32, p=0.001), and a negative correlation between the change from 18 months to baseline in TPCA PSV and cup area (r=-0.30, p=0.0022). With cup area as a dependent variable, in a multivariable linear regression, a model adjusted for age, race, sex and IOP, showed the change in TPCA PSV was the only significant predictor for the cup area changes (adjusted r-squared=0.20, P=0.0028). With horizontal integrated rim width as a dependent variable, TPCA RI at 18 months and OA PSV change from baseline were the two predictors for the change in horizontal integrated rim width adjusted for age, race, sex and IOP (adjusted r-squared=0.29, p<0.0001).
Decreasing blood flow in the short posterior ciliary arteries which perfuse the prelaminar and laminar regions of the ONH is associated with deterioration in optic nerve structural parameters in patients with OAG.
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