The evaluation of retinal venous pulse features as an indicator of venous disturbances in primary open-angle glaucoma patients
Purpose: To study the importance of retinal venous pulse changes in mechanisms of glaucoma development and in the estimation of progression of glaucomatous optic neuropathy. Methods: 286 patients (534 eyes) in age from 34 to 76 years with normalized intraocular pressure were investigated. The mean age was 63 years. All of patients underwent complex ophthalmic examinations and venous ophthalmodynamometry. Results: It has been revealed that spontaneous pulsation of the central retinal vein is 2.56 times less common for glaucoma patients, than for normal patients. It was marked a decrease of spontaneous venous pulsation frequency in cases of glaucoma progression; in 3rd stage of glaucoma it was revealed only in 6.7% of cases. Values of ophthalmodynamometric force (ODF) and retinal venous pulse pressure increase in cases of glaucoma progression, this confirms increased venous wall rigidity and intravenous pressure. Thus, disappearance of spontaneous venous pulse and increase of ODF are adverse prognostic factors for glaucoma patients. Received clinical and functional data indicates perspectiveness of SVP and ODF determination for diagnostic and prognostic purposes, and also assumes possible pathogenetic association between vascular abnormalities and nerve fibers atrophy in glaucoma patients. Conclusion: Complex estimation of venous pulse characteristics and morphologic functional changes assumes proper prediction of the speed of glaucomatous optic neuropathy's progression. The mechanism of positive effect of adequate hypotensive therapy also contains a venous haemodynamical restoration, that prevents the further loss of retinal ganglious cells.