Intracranial Pressure in Primary Open Angle Glaucoma, Normal Tension Glaucoma, and Ocular Hypertension: A Case–Control Study

Authors: John P. Berdahl 1 , Michael P. Fautsch 2 , Sandra S. Stinnett 1 and R. Rand Allingham 1

1From the Duke University Eye Center, Durham, North Carolina; and the
2Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.

PURPOSE. To compare intracranial pressure (ICP) in subjects with primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG; subset of POAG), and ocular hypertension (OHT) with that in subjects with no glaucoma.

METHODS. The study was a retrospective review of medical records of 62,468 subjects who had lumbar puncture between 1985 and 2007 at the Mayo Clinic. Of these, 57 POAG subjects, 11 NTG subjects (subset of POAG), 27 OHT subjects, and 105 control subjects met the criteria and were analyzed. A masked comparison of the relationship between ICP and other ocular and nonocular variables was performed by using univariate and multivariate analyses.

RESULTS. ICP was significantly lower in POAG compared with age-matched control subjects with no glaucoma (9.1 ± 0.77 mm Hg vs. 11.8 ± 0.71 mm Hg; P < 0.0001). Subjects with NTG also had reduced ICP compared with the control subjects (8.7 ± 1.16 mm Hg vs. 11.8 ± 0.71 mm Hg; P < 0.01). ICP was higher in OHT than in age-matched control subjects (12.6 ± 0.85 mm Hg vs. 10.6 ± 0.81 mm Hg; P < 0.05).

CONCLUSIONS. ICP is lower in POAG and NTG and elevated in OHT. ICP may play an important role in the development of POAG and NTG and in preventing the progression of OHT to POAG. Further prospective and experimental studies are warranted to determine whether ICP has a fundamental role in the pathogenesis of glaucoma.

Intracranial pressure and glaucoma

Authors: Berdahl, John Pa; Allingham, R Randb

Current Opinion in Ophthalmology: March 2010 - Volume 21 - Issue 2 - p 106–111 doi: 10.1097/ICU.0b013e32833651d8 Glaucoma: Edited by Donald L. Budenz

Purpose of review: Glaucoma remains a disease with an unclear basic pathophysiology. The optic nerve travels through two pressurized regions: the intraocular space and the intracranial space. Some authors have suggested that the relationship between intraocular pressure and intracranial pressure may play a fundamental role in the development of glaucoma.

Recent findings: Recent studies have shown that intracranial pressure is lower in patients with glaucoma and normal-tension glaucoma. Conversely, intracranial pressure appears to be elevated in patients with ocular hypertension. Early mathematical modeling studies have suggested that the counterbalance provided by intracranial pressure would be an important factor in the development of glaucoma.

Summary: The relationship between intraocular pressure and intracranial pressure may play an important role in the development of glaucoma.


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