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Farbduplexsonographie der retrobulbären Gefäße und Hyperkapnie bei Normaldruckglaukom

Color Doppler sonography of retrobulbar vessels and hypercapnia in normal tension glaucoma

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Zusammenfassung

Hintergrund

Eine veränderte Reaktivität des okulären Blutflusses auf einen gefäßerweiternden Stimulus kann Hinweis auf eine Störung der Blutflussregulation sein. In dieser Studie wurden retrobulbäre Blutfließgeschwindigkeiten bei Patienten mit Normaldruckglaukom (NDG) ohne Vasospasmen vor und während induzierter Hyperkapnie gemessen.

Material und Methoden

Es nahmen 16 Patienten mit NDG (Alter 58 ± 14 Jahre) und 16 Kontrollprobanden (Alter 50 ± 13 Jahre, p = 0,10) an dieser Studie teil. Blutfließgeschwindigkeiten [maximale systolische Geschwindigkeit („peak systolic velocity“, PSV) sowie enddiastolische Geschwindigkeit („end-diastolic velocity“, EDV)] und der Widerstandsindex („resistive index“, RI) der Aa. ophthalmica und centralis retinae wurden mithilfe der Farbduplexsonographie bestimmt. Die Blutfließgeschwindigkeiten wurden unter Raumluftbedingungen (Normokapnie) und unter Hyperkapnie [Erhöhung des endexspiratorischen Kohlenstoffdioxidpartialdrucks (pCO2) um 15%] gemessen. Blutdruck, Respirationsrate und Sauerstoffsättigung wurden simultan überwacht.

Ergebnisse

Unter Hyperkapnie zeigten die PSV und EDV (p = 0,044 resp. p = 0,037) der A. centralis retinae eine signifikant verminderte Reaktion bei den Patienten mit NDG im Vergleich zur Kontrollgruppe. Die Blutfließgeschwindigkeit der A. ophthalmica erhöhte sich signifikant unter Hyperkapnie (PSV: p = 0,039, EDV: p = 0,003). Es fand sich kein Unterschied zwischen beiden Gruppen (PSV: p = 0,65, EDV: p = 0,16). Der Einfluss der Hyperkapnie auf Blutdruck, Sauerstoffsättigung, Augeninnendruck und okulären Perfusionsdruck war nicht signifikant unterschiedlich in beiden Gruppen.

Schlussfolgerung

Die Reaktivität der Blutfließgeschwindigkeiten der A. centralis retinae ist bei Patienten mit NDG unter Hyperkapnie vermindert. Dies kann ein Hinweis auf eine gestörte Autoregulation bei diesen Patienten sein.

Abstract

Purpose

The aim of the study was to investigate retrobulbar flow velocities during hypercapnia in patients with normal tension glaucoma (NTG) without systemic vasospasm and jn controls.

Methods

A total of 16 NTG patients (mean age 58 ± 14 years) and 16 control subjects (mean age 50 ± 13 years, p = 0.10) were enrolled in this study. Flow velocities, peak systolic velocity (PSV), end-diastolic velocity (EDV) and resistive indices (RI) of the ophthalmic (OA) and central retinal arteries (CRA) were assessed using color Doppler imaging. Blood flow velocities were measured under normocapnic and hypercapnic conditions (increasing the end-tidal pCO2 by 15%). Blood pressure, ventilation rate and oxygen saturation were monitored simultaneously.

Results

During hypercapnia, velocity responses of the PSV (p = 0.044) and EDV (p = 0.037) of the CRA were significantly different in NTG patients and healthy controls, showing a greater increase of flow velocities in control subjects. Flow velocities of the OA increased significantly in both groups (PSV p = 0.039, EDV p = 0.003) during hypercapnia. Blood pressure, oxygen saturation and intraocular pressure changed similarly in both study groups with carbon dioxide provocation.

Conclusions

Velocity response to hypercapnia was reduced in the CRA of NTG patients compared to controls. This may indicate a faulty vasodilatory response in NTG patients without vasospastic disease.

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Authors and Affiliations

  1. Augenklinik , Universitätsklinikum Aachen, Pauwelsstr. 30, 52057, Aachen, Deutschland

    N. Plange, M. Bienert & A. Remky

  2. Dept. of Ophthalmology, Physiology and Biophysics, Indiana University School of Medicine, Indianapolis, USA

    A. Harris

  3. Augenzentrum Alsdorf, Alsdorf, Deutschland

    K.O. Arend

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  1. N. Plange
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  2. M. Bienert
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  3. A. Harris
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  4. A. Remky
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  5. K.O. Arend
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Correspondence to N. Plange.

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Plange, N., Bienert, M., Harris, A. et al. Farbduplexsonographie der retrobulbären Gefäße und Hyperkapnie bei Normaldruckglaukom. Ophthalmologe 109, 250–256 (2012). https://doi.org/10.1007/s00347-012-2524-0

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  • DOI: https://doi.org/10.1007/s00347-012-2524-0

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