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Impressum
Simultaneous measurement of optic nerve head and acral perfusion during cold provocation in normal tension glaucoma
Niederdräing N., Kremmer S., Selbach J. M., Hintzmann A., Steuhl K. P.
University Eye Hospital, Hufelandstr. 55, 45122 Essen, Germany
Objective: It has been shown that in glaucoma patients cold provocation
may influence optic nerve head perfusion and leads to temporary scotoma.
In the present study we investigated whether during cold provocation simultaneous
changes of peripheral and optic nerve head blood flow can be observed
and whether there are differences between NTG patients and normals.
Methods: 10 patients with normal tension glaucoma (NTG) and 10
healthy volunteers were examined before, during and after cold provocation
with 3°C cold water. Peripheral blood flow was measured at the finger
tips with laser doppler technique. Optic nerve head blood flow (temporal
superior, temporal inferior and nasal in the neuroretinal rim) was measured
by means of a Heidelberg Retina Flowmeter (HRF). Measurements were performed
before cold provocation (control), during 3 min with one foot standing
in 3°C cold water and during 3 minutes of recovery at room temperature.
Results: During cold provocation test, reduction of peripheral
blood flow down to 50% (of the initial value) and increase back to 80%
at the end of the 3 minutes. No significant difference between healthy
volunteers and NTG patients. In normals, recovery after 20 sec (100%)
and after 30 sec up to supranormal values (110-134%). In NTG, recovery
after 35 sec (100%) without excessive recovery reaction. Optic nerve head
blood flow: reduction to 90% after 80-120 sec of cold provocation in both
normals and NTG patients. Recovery phase: in healthy eyes, initial excessive
reaction up to 115-120% after 5-45 sec and afterwards continuously above
100%. In NTG, no supranormal values initially but undulating always below
100% (89-94%) during the recovery phase of more than 3 minutes.
Conclusion: Differences become evident especially in the recovery
phase after cold provocation. In NTG, there is a slower recovery at both
optic nerve head and finger tip as compared to normals. Optic nerve head
and acral perfusion show an excessive reaction at the beginning of the
recovery phase in normals but not in NTG.