개방각녹내장에서 야간혈압하강, 경동맥혈류저하, 뇌의 허혈성 변화가 녹내장 진행에 미치는 영향
Relationship Between Nocturnal Dip, Carotid Artery Blood Flow, Brain Ischemic Change in Open Angle Glaucoma
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목적: 목표 안압 이하로 안압이 일정하게 유지되는 개방각 녹내장 환자에서 야간 혈압 하강, 경동맥 혈류 저하, 그리고 뇌의 허혈성변화가 녹내장의 진행에 미치는 영향에 대해 알아보고자 했다. 대상과 방법: 24시간 활동 혈압 측정, 경동맥 색조 도플러 조영술, 뇌 자기 공명 영상 촬영을 시행한 개방각 녹내장 환자 74명(148안)을대상으로 야간 혈압 하강 유무, 경동맥 혈류 저하, 뇌의 허혈성 변화가 시야 결손의 진행에 미치는 영향을 살펴보았다. 결과: 야간 혈압 하강이 있는 정상 안압 녹내장, 원발성 개방각 녹내장에서 녹내장성 시야 결손의 진행이 야간 혈압 하강이 없는 경우에비해 유의하게 높게 나타났으며(정상 안압 녹내장: p-value 0.007; 원발성 개방각 녹내장: p-value 0.006), 정상 안압 녹내장에서경동맥의 혈류저하와 뇌의 허혈성 변화가 있는 경우 녹내장성 시야 결손 진행이 그렇지 않은 경우에 비해 유의하게 높게 나타났다(경동맥 색조 도플러 조영술: p-value 0.001; 뇌 자기 공명 영상 촬영: p-value 0.001). 하지만 원발성 개방각 녹내장에서는 통계적인유의성을 발견하지 못했다. 결론: 목표 안압 이하로 안압이 일정하게 유지됨에도 불구하고 녹내장의 진행을 보이는 개방각 녹내장 환자에서 24시간 활동 혈압측정, 경동맥 색조 도플러 조영술, 뇌 자기 공명 영상 촬영을 검사함으로써 허혈성 기전으로 인한 녹내장 진행 원인을 파악할 수 있으며, 녹내장의 진단, 경과 관찰 및 치료에 다양하게 활용할 수 있는 참고 자료가 될 것으로 생각한다.
Abstract
Purpose: To investigate the effect of nocturnal dip, carotid artery blood flow, and brain ischemic change on the progression of glaucomatous visual field defect in open-angle glaucoma (OAG) when IOP is less than the target pressure. Methods: We classified OAG patients (74 patients, 148 eyes) who maintained IOP less than the target pressure as normal tension glaucoma (NTG; 52 patients, 104 eyes) or primary OAG (POAG; 22 patients, 44 eyes). Additionally, we performed 24-hr ambulatory blood pressure monitoring (24-hr ABPM), carotid artery color Doppler U/S (CAD), brain MRI, and visual field (V/F) tests on the patients. Nocturnal dips less than 10% were classified as non-dippers, and dips greater than 10%as dippers. The relationships among nocturnal dip, carotid artery blood flow, brain ischemic change, and progression of glaucomatous V/F defect were examined. Results: In the case of dippers, glaucomatous V/F defects were aggravated, with a relative risk of approximately 1.74(NTG) and 2.91 (POAG) times that of non-dippers. In NTG, decreased carotid artery blood flow and brain ischemic change furthered glaucomatous V/F defects, with a relative risk of approximately 2.40 and 2.54 times that of normal carotid artery blood flow and brain MRI findings, respectively. However, in POAG, decreased carotid artery blood flow and brain ischemic change were not influenced by the progression of glaucomatous V/F defects. Conclusions: In dippers, decreased carotid artery blood flow and brain ischemic change caused a progression of glaucomatous V/F defects in NTG and POAG patients. Thus, performing 24-hr ABPM, CAD, and brain MRI should be helpful for glaucoma patients with progression of glaucomatous V/F defects even when the IOP is less than the target pressure. In addition, this analysis provides useful information regarding glaucoma diagnosis and treatment.
참고문헌 (41)
- Van Buskirk EM, "Glaucomatous optic neuropathy", Am J Ophthalmol, 113, pp.447~452 (1992)
- Armaly MF, "Ocular pressure and visual fields. A ten-year follow- up study", Arch Ophthalmol, 81, pp.25~40 (1969)
- Levens RZ, "Low tension glaucoma: a critical review and new material", Surv Ophthalmol, 24, pp.621~664 (1980)
- Perkins ES, "The Bedford glaucoma survey. I. Long-term follow-up of borderline cases", Br J Ophthalmol, 57, pp.179~185 (1973)
- Hayreh SS, "Progress in the understanding of the vascular etiology of glaucoma", Curr Opin Ophthalmol, 5, pp.26~35 (1994)
- Cartwright MJ, "Correlation of asymmetric damage with asymmetric intraocular pressure in normal-tension glaucoma", Arch Ophthalmol, 106, pp.898~900 (1988)
- Araie M, "Factors contributing to the progression of visual field damage in eyes with normal tension glaucoma", Ophthalmology, 101, pp.1440~1444 (1994)
- Ishida K, "Disk hemorrhage is a significantly negative prognostic factor in normal- tension glaucoma", Am J Ophthalmol, 129, pp.707~714 (2000)
- Drance S, "Risk factors for progression of visual field abnormalities in normal tension glaucoma", Am J Ophthalmol, 131, pp.699~708 (2001)
- Zeimer RC, "Association between intraocular pressure peaks and progression of visual field loss. Ophthalmology 1991;98:64-9. 11) Brubaker RF. Delayed functional loss in glaucoma. LII Edward Jackson Memorial Lecture", Am J Ophthalmol, 121, pp.473~483 (1996)
- Hayreh SS, "The blood supply of the optic nerve head and the evaluation of it: myth and reality", Prog Retin Eye Res, 20, pp.563~593 (2001)
- Gherghel D, "Relationship between ocular perfusion pressure and retrobulbar blood flow in patients with glaucoma with progressive damage", Am J Ophthalmol, 130, pp.597~605 (2000)
- Sehi M, "Relative change in diurnal mean ocular perfusion pressure: a risk factor for the diagnosis of primary open-angle glaucoma", Invest Ophthalmol Vis Sci, 46, pp.561~567 (2005)
- Hayreh SS, "Duke-elder Lecture. Systemic arterial blood pressure and the eye", Eye, 10(Pt 1), pp.5~28 (1996)
- Hayreh SS, "Nocturnal arterial hypotension and its role in optic nerve head and ocular ischemic disorders", Am J Ophthalmol, 117, pp.603~624 (1994)
- Béchetoille A, "Bresson-Dumont H. Diurnal and nocturnal blood pressure drops in patients with focal ischemic glaucoma", Graefes Arch Clin Exp Ophthalmol, 232, pp.675~679 (1994)
- 서홍융, "야간혈압하강이 녹내장의 진행에 미치는 영향", 대한안과학회지, 51(11), pp.1471~1478 (2010), 대한안과학회
- Baxter GM, "Color Doppler imaging of the eye: normal ranges, reproducibility, and observer variation", J Ultrasound Med, 14, pp.91~96 (1995)
- Niwa Y, "Reproducibility of color Doppler imaging for orbital arteries in Japanese patients with normal- tension glaucoma", Jpn J Ophthalmol, 42, pp.389~392 (1998)
- Birinci H, "Ocular blood flow in healthy and primary open-angle glaucomatous eyes", Ophthalmologica, 216, pp.434~437 (2002)
- Galassi F, "Color Doppler imaging in evaluation of optic nerve blood supply in normal and glaucomatous subjects", Int Ophthalmol, 16, pp.273~276 (1992)
- Nicolela MT, "Ocular hypertension and primary open-angle glaucoma: a comparative study of their retrobulbar blood flow velocity", J Glaucoma, 5, pp.308~310 (1996)
- Rankin SJ, "Color Doppler imaging and spectral analysis of the optic nerve vasculature in glaucoma", Am J Ophthalmol, 119, pp.685~693 (1995)
- Schumann J, "Interocular difference in progression of glaucoma correlates with interocular differences in retrobulbar circulation", Am J Ophthalmol, 129, pp.728~733 (2000)
- Arsava EM., "The role of MRI as a prognostic tool in ischemic stroke", J Neurochem, 123(Suppl 2), pp.22~28 (2012)
- Taha MM, "Cerebral ischemic lesions detected with diffusion-weighted magnetic resonance imaging after carotid artery stenting: Comparison of several anti-embolic protection devices", Neurol Med Chir, 49, pp.386~393 (2009)
- Suk Jung Kim, "Cerebral Ischemia Detected with Diffusion-Weighted MR Imaging after Protected Carotid Artery Stenting: Comparison of Distal Balloon and Filter Device", Korean Journal of Radiology, 8(4), pp.276~285 (2007), 대한영상의학회
- Roher AE, "Cerebral blood flow in Alzheimer's disease", Vasc Health Risk Manag, 8, pp.599~611 (2012)
- Ong K, "Comparative study of brain magnetic resonance imaging findings in patients with low-tensionglaucoma and control subjects", Ophthalmology, 102, pp.1632~1638 (1995)
- Leung DY, "Silent cerebral infarct and visual field progression in newly diagnosed normal-tension glaucoma: a cohort study", Ophthalmology, 116, pp.1250~1256 (2009)
- Collaborative Normal-Tension Glaucoma Study Group, "The effectiveness of intraocular pressure reduction in the treatment of normal- tension glaucoma", Am J Ophthalmol, 126, pp.498~505 (1998)
- Advanced Glaucoma Intervention Study, "2. Visual field test scoring and reliability", Ophthalmology, 101, pp.1445~1455 (1994)
- Kim J, "The Advanced Glaucoma Intervention Study (AGIS): 14. Distinguishing progression of glaucoma from visual field fluctuations", Ophthalmology, 111, pp.2109~2116 (2004)
- Plange N, "24-h blood pressure monitoring in normal tension glaucoma: night-time blood pressure variability", J Hum Hypertens, 20, pp.137~142 (2006)
- Graham SL, "Ambulatory blood pressure monitoring in glaucoma. The nocturnal dip", Ophthalmology, 102, pp.61~69 (1995)
- Hirotsu C, "Profile analysis of 24-hours measurements of blood pressure", Biometrics, 59, pp.907~915 (2003)
- Choi J, "Effect of nocturnal blood pressure reduction on circadian fluctuation of mean ocular perfusion pressure: a risk factor for normal tension glaucoma", Invest Ophthalmol Vis Sci, 47, pp.831~836 (2006)
- Collignon N, "Ambulatory blood pressure monitoring in glaucoma patients. The nocturnal systolic dip and its relationship with disease progression", Int Ophthalmol, 22, pp.19~25 (1998)
- Harris A, "The role of optic nerve blood flow in the pathogenesis of glaucoma", Ophthalmol Clin North Am, 18, pp.345~353 (2005)
- Akarsu C, "Color Doppler imaging in ocular hypertension and open-angle glaucoma", Grafes Arch Clin Exp Ophthalmol, 242, pp.125~129 (2004)
- Galassi F, "Ocular perfusion pressure and retrobulbar haemodynamics in pseudoexfoliation glaucoma", Grafes Arch Clin Exp Ophthalmol, 246, pp.411~416 (2008)