title: Cerebrospinal fluid pressure in glaucoma: a prospective study.
abstract: 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.
authors.affiliation: Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
authors.forename: Ruojin
authors.initials: R
authors.lastname: Ren
authors.forename: Jost B
authors.initials: JB
authors.lastname: Jonas
authors.forename: Guoghong
authors.initials: G
authors.lastname: Tian
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhen
authors.forename: Ke
authors.initials: K
authors.lastname: Ma
authors.forename: Shuning
authors.initials: S
authors.lastname: Li
authors.forename: Hongtao
authors.initials: H
authors.lastname: Wang
authors.forename: Bin
authors.initials: B
authors.lastname: Li
authors.forename: Xiaojun
authors.initials: X
authors.lastname: Zhang
authors.forename: Ningli
authors.initials: N
authors.lastname: Wang
mesh_terms: 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