Cerebrospinal fluid pressure in glaucoma: a prospective study.
OBJECTIVE
To assess whether a low cerebrospinal fluid pressure (CSF-P) is associated with open-angle glaucoma in eyes with normal intraocular pressure (IOP).


METHODS
Prospective, interventional study.


METHODS
The study included 43 patients with open-angle glaucoma (14 with a normal IOP, and 29 with an elevated IOP) and 71 subjects without glaucoma.


METHODS
All patients underwent standardized ophthalmologic and neurologic examinations and measurement of lumbar CSF-P.


METHODS
Cerebrospinal fluid pressure and IOP.


RESULTS
Lumbar CSF-P was significantly (P<0.001) lower in the normal IOP glaucoma group (9.5+/-2.2 mmHg) than in the high IOP glaucoma group (11.7+/-2.7 mmHg) or the control group (12.9+/-1.9 mmHg). The trans-lamina cribrosa pressure difference (IOP minus CSF-P) was significantly (P<0.001) higher in the normal IOP glaucoma group (6.6+/-3.6 mmHg) and the high-IOP glaucoma group (12.5+/-4.1 mmHg) than in the control group (1.4+/-1.7 mmHg). The extent of glaucomatous visual field loss was negatively correlated with the height of the CSF-P and positively correlated with the trans-lamina cribrosa pressure difference. In the control group, CSF-P was significantly correlated with both systolic blood pressure (P = 0.04) and IOP (P<0.001). The trans-lamina cribrosa pressure difference was not significantly associated with blood pressure (P = 0.97).


CONCLUSIONS
In open-angle glaucoma with normal IOP, CSF-P is abnormally low, leading to an abnormally high trans-lamina cribrosa pressure difference. Pathogenetically, a low CSF-P in normal-IOP glaucoma may be similar to a high IOP in high-IOP glaucoma. Consequently, the glaucomatous visual field defect is positively correlated with the trans-lamina cribrosa pressure difference and inversely correlated with the CSF-P. In nonglaucomatous subjects, CSF-P, blood pressure, and IOP are significantly associated with each other.
Ren
Ruojin
R
Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Jonas
Jost B
JB
Tian
Guoghong
G
Zhen
Yi
Y
Ma
Ke
K
Li
Shuning
S
Wang
Hongtao
H
Li
Bin
B
Zhang
Xiaojun
X
Wang
Ningli
N
D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D015170:Cerebrospinal Fluid Pressure / Q000502:physiology*; D005260:Female; D005902:Glaucoma, Open-Angle / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D019585:Intracranial Hypotension / Q000503:physiopathology*; D007429:Intraocular Pressure / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009901:Optic Nerve Diseases / Q000209:etiology / Q000503:physiopathology*; D011446:Prospective Studies; D013129:Spinal Puncture; D014794:Visual Fields / Q000502:physiology