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RL G Bizzarro, AS Hafez, MR Lesk; Changes in Optic Nerve Head Blood Flow after Therapeutic Intraocular Pressure Reduction in Primary Open Angle Glaucoma and Juvenile Open Angle Glaucoma Patients . Invest. Ophthalmol. Vis. Sci. 2002;43(13):314.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To compare changes in optic nerve head (ONH) and peripapillary retinal blood flow following therapeutic intraocular pressure (IOP) reduction in patients with juvenile open angle glaucoma (JOAG) and primary open angle glaucoma (POAG), using scanning laser Doppler flowmetry (SLDF) full-field perfusion analysis. Methods: JOAG patients (N=7) with clinical indication for therapeutic IOP reduction were prospectively enrolled. POAG patients (N=7) were matched for percentage IOP reduction and for post-reduction IOP. Patients underwent SLDF imaging before and after therapeutic IOP reduction. All patients had IOP reductions more than 15% and a minimum of four weeks follow up. A mean of five blood flow measurements was obtained by SLDF full-field perfusion analysis using Heidelberg Retina Flowmeter images. Statistical analysis used the two-tailed distribution paired t-test. Results: The mean (±SD) age the POAG group was 67±8 years compared to 30±10 years in the JOAG group (p=0.00001). Both groups had mean percentage IOP reduction of 36% after treatment and mean post-reduction IOP of 16 mmHg. In the POAG patients mean rim blood flow increased by 85% [from 188±80 to 348±149, p=0.03], while mean temporal peripapillary retinal blood flow decreased by 9.3% [p=0.41] and mean nasal peripapillary retinal blood flow increased by 6.1% [p=0.59]. In contrast to the POAG group, the mean rim blood flow of the JOAG group showed no significant change [1.9% decrease from 155±65 to 152±49, p=0.88]. The mean temporal peripapillary retinal blood flow [0.4% decrease, p=0.97] and nasal peripapillary retinal blood flow [8.5% increase, p=0.77] also did not change significantly. Conclusion: Matched for percentage IOP reduction and post reduction IOP, POAG patients had a significant improvement in ONH blood flow, which may indicate defective ONH autoregulation. In contrast, JOAG patients, whose primary defect is not thought to be vascular, had stable ONH blood flow. Peripapillary retinal flow showed no significant change in either group.
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