Retinal venous pressure is higher than the airway pressure and the intraocular pressure during the Valsalva manoeuvre

Abstract Background The retinal venous pressure (RVP) is a determining factor for the blood supply of the retina as well as the optic nerve head and until recently has been measured by contact lens dynamometry (CLD). A new method has been developed, potentially offering better acceptance. The applicability and the results of both methods were compared. Methods The type of this study is cross sectional. The subjects were 36 healthy volunteers, age 26 ± 5 years (mean ± s). Tonometry: rebound tonometer (RT) (iCare). The measurements were performed during an increase in airway pressure of 20 mmHg (Valsalva manoeuvre). Principle of RVP measurement: the central retinal vein (CRV) is observed during an increase of intraocular pressure (IOP) and at the start of pulsation, which corresponds with the RVP. Two different instruments for the IOP enhancement where used: contact lens dynamometry and the new instrument, IOPstim. Principle: a deflated balloon of 8 mm diameter—placed on the sclera laterally of the cornea—is filled with air. As soon as a venous pulsation occurs, filling is stopped and the IOP is measured, equalling the RVP. Examination procedure: randomization of the sequence: CLD or IOPstim, IOP, mydriasis, IOP three single measurements (SM) of the IOP with RT or of the pressure increase with CLD at an airway pressure of 20 mmHg, 5 min break, IOP, and three SM using the second method at equal pressure (20 mmHg). Results Spontaneous pulsation of the CRV was present in all 36 subjects. Pressures are given in mmHg. IOP in mydriasis 15.6 ± 3.3 (m ± s). Median RVP (MRVP)) of the three SM: CLD/IOPstim, 37.7 ± 5.2/24.7 ± 4.8 (t test: p < 0.001). Range of SM: 3.2 ± 1.8/2.9 ± 1.3 (t test: p = 0.36). Intraclass correlation coefficient (ICC) of SM: 0.88/0.83. ANOVA in SM: p = 0.48/0.08. MRVP CLD minus MRVP IOPstim: 13.0 ± 5.6. Ratio MRVP CLD/MRVP IOPstim: 1.56 ± 3.1. Cooperation and agreeability were slightly better with the IOPstim. Conclusion This first study with the IOPstim in humans was deliberately performed in healthy volunteers using Valsalva conditions. As demonstrated by ICC and ANOVA, reproducible SM can be obtained by both methods and the range of the SM does not differ greatly. The higher MRVP in CLD could be explained by the different directions of the force vectors.

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The Distribution of Retinal Venous Pressure and Intraocular Pressure Differs Significantly in Patients with Primary Open-Angle Glaucoma

Klinische Monatsblätter für Augenheilkunde ◽

10.1055/a-1318-9991 ◽

2021 ◽

Author(s):

Richard Stodtmeister ◽

Wiebke Koch ◽

Sylvana Georgii ◽

Karin R. Pillunat ◽

Eberhard Spörl ◽

...

Keyword(s):

Intraocular Pressure ◽

Contact Lens ◽

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Venous Pressure ◽

Open Angle ◽

Retinal Venous Pressure ◽

Number Of Patients ◽

Β Blocker ◽

Β Blockers

Abstract Introduction Until now, venous pressure within the eye has widely been equated with intraocular pressure (IOP). Measurements with dynamometers calibrated in instrument units or in force showed that the retinal venous pressure (RVP) may be higher than the IOP in glaucoma patients. In this study, the RVP was measured with a contact lens dynamometer calibrated in mmHg. Methods Study type: cross-sectional. Subjects: Fifty consecutive patients with primary open-angle glaucoma (POAG) who underwent diurnal curve measurement under medication. Age: 69 ± 8 years. Measurement of RVP: contact lens dynamometry. IOP measurement: dynamic contour tonometry. Results Pressures are given in mmHg. In all 50 patients, the IOP was 15.9 (13.6; 17.1) [median (Q1; Q3)], and the RVP was 17.4 (14.8; 27.2). The distribution of the IOP was normal and that of the RVP was right skewed. In the subgroup of 34 patients with spontaneous pulsation of the central retinal vein (SVP), the IOP and therefore, by definition, the RVP was 16.5 (13.7; 17.4). In the subgroup of 16 patients without SVP, the IOP was 14.8 (13.3; 16.4), and the RVP was 31.3 (26.2; 38.8) (p ≤ 0.001). In systemic treatment, the prescribed drugs were (the number of patients is given in parentheses): ACE inhibitors (20), β-blockers (17), angiotensin II-receptor blockers (13), calcium channel blockers (12), diuretics (7). No difference in RVP was observed between patients receiving these drugs and not receiving them, except in the β-blocker group. Here, the 17 patients with systemic β-blockers had a median RVP of 15.6 mmHg and without 20.2 mmHg (p = 0.003). In the 16 patients with a higher RVP than IOP, only one patient received a systemic β-blocker. The median IOP was 15.7 mmHg with systemic β-blockers and 16.1 mmHg without (p = 0.85). Conclusion In a subgroup of 16 of the 50 patients studied, the RVP was greater than the IOP by a highly statistically and clinically significant degree. According to the widely accepted thinking on the pathophysiology of retinal and optic nerve head circulation, the blood flow in these tissues may be much more compromised in this group of patients than has been assumed. They may be identified by a missing SVP. Topical and systemic medications showed no statistically significant influence on the RVP, except for the systemic β-blockers, in which the RVP was lower by 4.6 mmHg than for the patients who did not receive these drugs (p = 0.003).

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Central retinal venous pressure is higher than intraocular pressure during amateur trumpet playing

Graefe s Archive for Clinical and Experimental Ophthalmology ◽

10.1007/s00417-019-04334-x ◽

2019 ◽

Vol 257 (7) ◽

pp. 1467-1472 ◽

Cited By ~ 1

Author(s):

Egbert Matthé ◽

Marie-Caroline Schlief ◽

Sylvana Georgii ◽

Richard Stodtmeister ◽

Lutz E. Pillunat ◽

...

Keyword(s):

Intraocular Pressure ◽

Venous Pressure ◽

Retinal Venous Pressure

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The retinal venous pressure at different levels of airway pressure

Graefe s Archive for Clinical and Experimental Ophthalmology ◽

10.1007/s00417-020-04796-4 ◽

2020 ◽

Vol 258 (11) ◽

pp. 2419-2424 ◽

Cited By ~ 1

Author(s):

Sofie Heimann ◽

Richard Stodtmeister ◽

Lutz E. Pillunat ◽

Naim Terai

Keyword(s):

Airway Pressure ◽

Venous Pressure ◽

Retinal Venous Pressure ◽

Different Levels

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Retinal venous pressure is decreased after anti-VEGF therapy in patients with retinal vein occlusion–related macular edema

Graefe s Archive for Clinical and Experimental Ophthalmology ◽

10.1007/s00417-020-05068-x ◽

2021 ◽

Author(s):

Teruyo Kida ◽

Josef Flammer ◽

Katarzyna Konieczka ◽

Tsunehiko Ikeda

Keyword(s):

Macular Edema ◽

Intravitreal Injection ◽

Retinal Vein Occlusion ◽

Venous Pressure ◽

Decisive Role ◽

Retinal Venous Pressure ◽

Vein Occlusion ◽

Anti Vegf ◽

Significant Difference ◽

Endothelial Growth Factor

Abstract Purpose The pathomechanism leading to retinal vein occlusion (RVO) is unclear. Mechanical compression, thrombosis, and functional contractions of veins are discussed as the reasons for the increased resistance of venous outflow. We evaluated changes in the retinal venous pressure (RVP) following intravitreal injection of anti-vascular endothelial growth factor (VEGF) agent to determine the effect on RVO-related macular edema. Methods Twenty-six patients with RVO-related macular edema (16 branch RVOs [BRVOs] and 10 central RVOs [CRVOs], age 72.5 ± 8.8 years) who visited our hospital were included in this prospective study. Visual acuity (VA), intraocular pressure (IOP), central retinal thickness (CRT) determined by macular optical coherence tomography, and RVP measured using an ophthalmodynamometer were obtained before intravitreal injection of ranibizumab (IVR) and 1 month later. Results Comparison of the BRVOs and CRVOs showed that VA was significantly improved by a single injection in BRVOs (P < 0.0001; P = 0.1087 for CRVOs), but CRT and RVP were significantly decreased without significant difference in IOP after the treatment in both groups (P < 0.0001). Conclusion The anti-VEGF treatment resulted in a significant decrease in the RVP, but the RVP remained significantly higher than the IOP. An increased RVP plays a decisive role in the formation of macula edema, and reducing it is desirable.

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Intra-ocular pressure changes during maximal isometric contraction: Does this reflect intra-cranial pressure or retinal venous pressure?

Neurological Research ◽

10.1080/01616412.1999.11740925 ◽

1999 ◽

Vol 21 (3) ◽

pp. 243-246 ◽

Cited By ~ 59

Author(s):

Rob D. Dickerman ◽

Greg H. Smith ◽

Len Langham-Roof ◽

Walter J. McConathy ◽

John W. East ◽

...

Keyword(s):

Isometric Contraction ◽

Venous Pressure ◽

Retinal Venous Pressure ◽

Intra Ocular Pressure ◽

Ocular Pressure ◽

Pressure Changes ◽

Intra Cranial Pressure

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The retinal venous pressure ‐ A new measurable parameter in glaucoma risk assessment

Acta Ophthalmologica ◽

10.1111/j.1755-3768.2019.8165 ◽

2019 ◽

Vol 97 (S263) ◽

Author(s):

Richard Stodtmeister

Keyword(s):

Risk Assessment ◽

Venous Pressure ◽

Retinal Venous Pressure ◽

Measurable Parameter

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The effect of nifedipine on retinal venous pressure of glaucoma patients with the Flammer-Syndrome

Graefe s Archive for Clinical and Experimental Ophthalmology ◽

10.1007/s00417-015-3001-7 ◽

2015 ◽

Vol 253 (6) ◽

pp. 935-939 ◽

Cited By ~ 12

Author(s):

L. Fang ◽

S. Turtschi ◽

Maneli Mozaffarieh

Keyword(s):

Venous Pressure ◽

Flammer Syndrome ◽

Retinal Venous Pressure

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Evaluation of Possible Changes in Intraocular Pressure and Optical Coherence Tomography Measurements in Severe OSAS Patients After 3 Month Positive Airway Pressure Treatment

10.21203/rs.3.rs-395658/v1 ◽

2021 ◽

Author(s):

Nursel Dikmen ◽

Ayse Idil Cakmak ◽

Selma Urfalıoğlu

Keyword(s):

Optical Coherence Tomography ◽

Intraocular Pressure ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Corneal Thickness ◽

Optical Coherence ◽

Fiber Layer ◽

Before And After ◽

Sleep Parameters ◽

Pre Treatment

Abstract Purpose: To identify and compare possible changes in intraocular pressure (IOP), macular and peripapillary retinal nerve fiber layer (RNFL) thickness using optical coherence tomography (OCT) before and after 3 months of positive airway pressure (PAP) in patients with severe OSAS.Materials and Methods: Twenty-five patients diagnosed with severe OSAS in the neurology sleep outpatient clinic were included in the study. Ophthalmologic examinations were performed at the time of diagnosis and after 3 months of PAP treatment. Statistical analysis of comparisons of IOP and OCT measurements taken before and after PAP treatment was performed. Before treatment, the correlations between central corneal thickness (CCT), body mass index (BMI), OCT, IOP and sleep parameters were statistically investigated.Results: When comparisons were made for both eyes, after 3 months of PAP treatment, a statistically significant decrease in IOP, thickening of the macula, and thinning of RNFL in the superior nasal sector were found when compared with the measurements previously taken at the time of diagnosis (p <0.05). There was no correlation between pre-treatment IOP, OCT, CCT, BMI and sleep parameters.Discussion: The inflammatory effects of OSAS on the IOP and macula have been shown to be reversible with a 3-month PAP treatment, but the reversibility of the neurodegenerative effects of OSAS on RNFL with this treatment seems controversial. OCT is a promising technique for monitoring disease progression in patients with severe OSAS under PAP treatment.

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