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Differences between Primary and Secondary Chronic Open-angle Glaucomas in Retinal and Optic-disc Capillary Perfusion Measurements

1Dzialach M., 2Harazny J., 3Michelson G., 4Budde W. M., 3Mardin C. Y., 4Jonas J. B.,
1Friedrich-Alexander-Universität, Augenklinik, ERG-Labor (Erlangen)
2Friedrich-Alexander-Universität, Augenklinik, Labor für okuläre Perfusion (Erlangen)
3Friedrich-Alexander-Universität, Augenklinik (Erlangen)
4Ruprecht-Karls-Universität Heidelberg, Fakultät für klinische Medizin Mannheim, Augenklinik (Mannheim)

Purpose: For the different forms of the chronic open-angle glaucomas, various pathogenic mechanisms, such as a vascular perfusion disturbance, have been discussed as reason of optic nerve damage. It was, therefore, the purpose of the present study to examine whether the different types of chronic open-angle glaucoma vary with respect to their correlations with capillary perfusion measurements of the optic disc and the parapapillary retina.
Methods: The study included 290 eyes of patients with primary open-angle glaucoma (age (mean ± SD): 51.1±12.3 years; refractive error: -1.34±2.42 diopters), 362 eyes of patients with secondary chronic open-angle glaucoma due to pseudoexfoliation syndrome or primary melanin dispersion syndrome (age: 43.20±13.85 years; refractive error: -0.66±2.49 diopters), 133 eyes of patients with normal-pressure glaucoma (age: 55.50±9.99 years; refractive error: -0,57±2,61 diopters), and 302 eyes of normal subjects (age: 43.78±14.66 years; refractive error: -0.58±1.54 diopters). All patients and subjects were prospectively examined as part of the Erlanger Glaucoma Registry. For all study participants, 15 degree color stereo optic disc photographs were taken and morphometrically examined. Additionally, the mean capillary blood flow in the neuroretinal rim and in the retina at the temporal and nasal optic disc border was measured by confocal laser scanning flowmetry (Heidelberg Retinal Flow Meter).
Results: The correlation coefficients of the relationships between the capillary perfusion measurements and the neuroretinal rim area did not vary markedly between the patients with primary open-angle glaucoma (r=0.18 (p<0.001); r=0.10 (p=0.015); r=0.10 (p=0.017)), the patients with normal-pressure glaucoma (r=0.12 (p=0.01); r=0.11 (p=0.02); r=0.10 (p=0.03), and the patients with secondary open-angle glaucoma (r=0.15 (p<0.001); r=0.19 (p<0.001); r=0.07 (p=0.077)). For all three study groups, there was a marked scattering of the results.
Conclusions: In most of the primary or secondary chronic open-angle glaucomas, the loss of optic nerve fibers as measured by neuroretinal rim area is associated with decreased capillary perfusion measurements, without major differences between the various types of chronic open-angle glaucoma.

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