Hemodynamic features in patients with simple and pseudoexfoliation primary open-angle glaucoma and ophthalmic hypertension. Part 2.

OBJECTIVE: To assess the features of regional hemodynamics in patients with primary open-angle (POAG), pseudoexfoliation glaucoma (PEG) (and on the paired eye without glaucoma) and ocular hypertension (OH).
METHODS: According to inclusion and non-inclusion criteria, out of 1370 patients under our observation we picked 290 patients (540 eyes) with POAG, PEG and OH, as well as healthy people for control. At baseline all patients underwent visometry, tonometry, elastotonometry (assessed five times in 3 months, with mean value of all measurements used for the calculations), standard automated perimetry (SAP), optical coherence tomography (OCT) of the macular zone and optic disc, pachymetry (Spectralis OCT, «Heidelberg Engineering», Germany), keratorefractometry, ultrasound dopplerography (USDG) of orbital vessels (Toshiba Aplio XG), with intraocular (IOP) and arterial blood (BP) pressure measurement just before USDG. The analysis of structural and functional differences was presented in the previous publication (Part 1) [1].
RESULTS: The peak systolic (Vmax) 28.0 (22.8; 34.0); 29.2±9.0 cm/sec and end diastolic (Vmin) 5.7 (4.3; 7.7); 6.0±2.6 cm/sec blood flow velocity in the ophthalmic artery (OA) in patients with POAG was lower than in other groups, however, the difference was statistically significant only when compared to PEG groups 30.6 (24.0; 38.2); 31.2±10.1/6.8 (4.2; 8.6); 7.3±5.2 cm/sec and unilateral PEG 27.6 (24.1; 36.7); 30.4±9.3 / 6.0 (4.4; 7.4); 6.7±4.0 cm/sec, while blood flow velocity in OH, norm, PEG and unilateral PEG groups did not differ, when compared between themselves. Central retinal artery (CRA) hemodynamics also allows one to speak of the existence of a hemodynamic compensatory mechanism, a statistically significant increase in Vmax, in the OH group 11.8 (9.5; 14.3); 12.1±3.5 and unilateral PEG 11.8 (8.7; 13.9); 11.7±3.9, and at 10.7 (8.8; 13.0); 11.0±3.2, the Vmax level is comparable to the normal values of 10.0 (8.3; 11.9); 10.5±3.0 (which is probably related to IOP compensation), but differed from unilateral PEG group values at the statistical hypothesis level. Reduction of CRA blood flow velocity in patients with PEG reached 10.9 (9.2; 13.0); 11.4±3.7, in comparison with «PEG-», also differing from the normal values at the statistical hypothesis level. Also it’s important to note a higher level of Vmin in the OH group: 2.4 (1.7; 3.4); 2.7±1.4 and PEG patients 2.4 (1.7; 3.1); 2.7±1.7 compared with the norm 2.15 (1.7; 2.8); 2.3±0.9, Vmin in groups of POAG 2.5 (1.7; 2.9); 2.4±0.9 and PEG also differed at the level of the statistical hypothesis, increasing with PEG. Hemodynamic analysis of choroid parameters detected similar changes in OA with a tendency towards Vmax increase in patients with OH and unilateral PEG. There was no statistically significant difference in hemodynamic parameters of the posterior short ciliary arteries (PSCA).
CONCLUSION: Our study found convincing evidence of the difference in the regional hemodynamics characteristics, depending on the diagnosis, in the OA, CRA, CRV, and the temporal choroid. The increase in velocity characteristics in these vessels is probably a consequence of compensatory defense mechanisms in response to increased intraocular pressure. Velocity indicators decrease shows a disruption in the adaptation mechanisms and can be a predictor of the transition from a «healthy» state to a mild glaucoma, which is especially important for patients with OH and unilateral PEG.

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