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Cieľ: Lamina cribriformis je hranicou 2 tlakov: vnútroočného tlaku (VOT) a intrakraniálneho tlaku (IKT). Rozdiel medzi VOT a IKT sa označuje ako translaminárny gradient (TLG). Cieľom bolo sledovať glakomatóznu progresiu (zorné pole, fundus vyšetrenie, HRT vyšetrenia) bez / s lokálnou antiglaukomatóznou terapiou) vo vzťahu k TLG. Pacienti a metodika: Hodnotenie významu TLG bolo skúmané v dvoch skupinách. I. skupina 57 pacientov s diagnostikovaným a liečeným primárnym glaukómom s otvoreným uhlom (PGOU), 10 pacientov s okulárnou hypertenziou (OH), 7 pacientov s nízkotenzným glaukómom (NTG) a 75 zdravých bez glaukómu. Hodnotenia TLG boli realizované jednorázovo a retrospektívne. V II. skupine boli prospektívne sledovaní 14 pacienti s OH a 24 pacientov s novozisteným PGOU bez nastavenej terapie. Vyšetrenia boli realizované 4x s odstupom 10–11 mesiacov. Všetky vyšetrenia zahrňovali základné očné vyšetrenia, ORA tonometriu, HRT vyšetrenie, gonioskopiu, farebný Doppler sonografiu ciev oka a očnice. Venózny pulzačný tlak (VPT) bol zaznamenaný oftalmodynamometrom Meditron (D-ODM). V prípadoch spontánnej venóznej pulzácie Vena centralis retinae, bol VPT považovaný za tlak rovnaký ako VOT Pre výpočet TLG bol použitý vzorec podľa Querfurtha IKT = 0,29 + 0,74 (VOT / PI (AO )). [PI(AO) – index pulzatility z arteria ophthalmica (AO)]. Výsledky: I. skupina: TLG bol v kontrolnej skupine bez glaukómu: 12,2 ? 2,0 torr. V skupine NTG: 9,0 ? 1,70 torr. PGOU: 11,1 ? 1,91 torr. OH: 12,6 ? 0.85 torr. Samotný IKT neprejavuje signifikantný vzťah k prítomnosti glaukómu, okulárnej hypertenzie. II. skupina: Pacienti s OH (14 pacientov) mali TLG v 12 prípadoch 3,8 ? 1,2 torr. 2 pacienti (OH) mali TLG 10 torr. a 15 torr. U jedného z nich (TLG = 15 torr.) bola po 4 rokoch zaznamenané glaukomatózna progresia. V skupine PGOU pred liečbou bol u všetkých pacientov bol TLG 15,0 ? 4,8 torr. Po nastavení lokálnej antiglaukomatóznej terapie a úprave VOT, sa u 20 pacientov znížil TLG na 3,6 ? 1,3 torr. Záver: TLG preukázal signifikantný vzťah k progresii glaukómu. Riziko glaukomatózneho poškodenia stúpa priamo úmerne so zvyšujúcou sa hodnotou translaminárneho gradientu. Translaminárny gradient slúži pre upresnenie tzv. „cieľového“ vnútroočného tlaku. Hodnotenie TLG má význam pri okulárnych poškodeniach (okulárna hypertenzia, glaukóm, cievne oklúzie, neuropatie zrakového nervu), intrakraniálnych procesoch, orbitopatiách, pre výber vhodného antiglaukomatika.

Objective: The cribriform plate is a threshold of the intraocular pressure (VOT) and of the intracranial pressure (IKT). The difference between the VOT and IKT is referred to as translaminar gradient (TLG). The goal was to evaluate the Glaucoma progression (visual field, fundus examination, HRT) with / without topical anti-glaucomatous therapy) in relation to the TLG. Patients and methods: the significance of TLG has been studied in two groups. I. Group: 57 patients diagnosed and treatment of Primary Open-Angle Glaucoma (PGOU), 10 patients with Ocular hypertension (OH), 7 patients with Normal-Tension Glaucoma (NTG), and 75 healthy without glaucoma. The examinations of TLG were carried out once and retrospectively. In II. group there were prospectively studied 14 patients with OH and 24 patients with newly detected PGOU without local therapy. The examinations were performed 4 times at intervals of 10 to 11 months. All tests included a basic eye examination, ORA tonometry, HRT examination, gonioscopy, Color Doppler sonography of blood vessels of the eye and orbit. Venous pulsation pressure (VPT) has been recorded by the Ophthalmodynamometer Meditron (D-ODM). In case of spontaneous retinal venous pulsation, VPT was considered as the same pressure as the VOT. The TLG was calculated with formula of Querfurth: ICT = 0.29 + 0.74 (VOT / PI (AO)). [PI(AO) – Pulsatility index of the Ophthalmic artery (AO)]. Results: I. group: TLG was in the control group without Glaucoma: 12.2 ? 2.0 torr. The NTG group: 9.0 ? 1.70 mm Hg. PGOU: 11.1 ? 1.91 mm Hg. OH: 12.6 ? 0.85 mm Hg. IKT alone does not show a significant relationship to the presence of glaucoma, ocular hypertension. II. Group: The average TLG in Ocular Hypertension (14 patients) has been 3.8 ? 1.2 torr. 2 patients (OH) had TLG 10 torr. and 15 torr. After 4 years in one of them (TLG = 15 torr.) there was recorded Glaucoma progression. In the PGOU group before antiglaucoma therapy, TLG was 15.0 ? 4.8 torr for all patients. After setting up local anti-glaucoma therapy and decreasing VOT, the TLG in 20 patients reduced to 3.6 ? 1.3 mm Hg. Conclusion: TLG showed a significant relationship to the Glaucoma progression. The risk of glaucomatous damage increases proportionally with increasing Translaminar gradient. Translaminar gradient can be use to refine the so-called. “Target VOT”. TLG has a role in ocular damage (ocular hypertension, glaucoma, vascular occlusion, optic neuropathy), intracranial damage, orbitopathy, selection of appropriate antiglaucomatous therapy.

Klíčová slova
translaminární gradient,
MeSH
glaukom s otevřeným úhlem patofyziologie terapie MeSH
glaukom * patofyziologie terapie MeSH
intrakraniální tlak MeSH
kohortové studie MeSH
lidé MeSH
nitrooční tlak MeSH
oční hypertenze MeSH
oftalmodynamometrie MeSH
progrese nemoci MeSH
zrakové testy MeSH
Check Tag
lidé MeSH

Článek online

Hodnotenie intrakraniálneho tlaku oftalmológom
[Intracranial pressure evaluation by ophthalmologist]

Česká a slovenská oftalmologie. 2017 ; 73 (2) : 57-60.

ISSN 1211-9059
Medvik
Zdroj

Hodnota IKT má význam pri diagnostike niektorých ochorení oka a očnice. Metódy pre priame meranie intrakraniálneho tlaku (IKT) sú exaktné, ale sú invazívne a je určité riziko infekcie a poškodenia tkanív. V súčasnosti sú preukazné 2 nepriame metódy: Digitálna oftalmodynamometria (D-ODM) a Transkraniálna Doppler ultrasonografia (TDU). D-ODM je neinvazívna metóda na meranie venózneho pulzačného tlaku (VPT). VPT získame hodnotením pulzačných fenoménov. Za fyziologických podmienok (aby bol zachovaný prietok krvi) VPT nemôže byť nižší ako IKT a intraorbitálny tlak (IorbitT). Ak úmyselne zvýšime VPT tak, aby sa vyrovnal súčasnému IKT alebo IorbitT – dochádza k pulzácii VCR. Aproximatívny IKT vypočítame kalkuláciou VPT vo vzorci: IKT = 0,903 - (VPT) - 8,87, alebo IKT = 0,29 + 0,74 (VOT / PI (AO )). [VOT = vnútroočný tlak. PI – Index pulzatility arteriae ophthalmicae získame pomocou farebnej Doppler ultrasonografie]. Výpočet približného IKT je možné aj pomocou matematických vzorcov: IKT = 0.55 × BMI index (kg/m2) + 0.16 × KTD (mmHg) – 0,18 × age (roky) – 1,91. [ KTD – diastolický krvný tlak , BMI – Body masters index], alebo: IKT = 16,95 x OSASW09 + 0,39 x BMI + 0,14 + TKS – 20,90 [OSASW095: šírka orbitálneho subarachnoideálneho priestoru vo vzdialenosti 9 mm za bulbom (vyšetrenie nukleárnej magnetickej rezonancie), BMI: Body mass index, TKS: stredný arteriálny tlak.] Fyziologické hodnoty VPT sú do 15 torr. Nad 20 torr. je už riziko zvýšenia intrakraniálneho tlaku. Fyziologický vnútroočný tlak je nižší než VPT o cca 5 torr. Záver: D-ODM je užitočnou skríningovou metódou pri hodnotení IKT v rámci diagnostiky hydrocefalu, mozgových tumorov, mozgových krvácaní a po mozgovej traume a tiež pri očných ochoreniach: glaukómy (okulárna hypertenzia), orbitopatie (endokrinná orbitopatia), ischemická / neischemická oklúzia ciev oka, nepriama detekcia IKT, karotído-kavernózna fistula, amaurosis fugax, neuropatie zrakového nervu. D-ODM je relevantná pre okamžité vyhodnotenie IKT, ale nie je vhodná pre kontinuálne monitorovanie. Vzhľadom k tomu, že sa môže opakovať, je vhodná pri kontrolách pacienta s podozrením na zvýšený IKT.

The value of ICT is important in diagnosis of the diseases of the eye and orbit Methods for direct measurement of intracranial pressure (ICT) are exact, but they are invasive and there is some risk of infection and damage of the tissue. Currently there are 2 valid indirect methods of mesurement of IKT. Digital Ophthalmodynamometry (D-ODM) and Transcranial Doppler ultrasonography (TDU). D-ODM is a non-invasive method for measuring of the Pulsating Venous Pressure (VPT). We can measure VPT by the pulse phenomena. Physiologically (to be maintained blood flow) VPT not be less than the ICT and intraorbital pressure (IorbitT). If we raise the VPT to compensate the current IKT (or IorbitT) - there is a pulsation VCR. We can calculate aproxymative IKT with the formula: IKT = 0.903 - (VPT) - 8.87, or IKT = 0.29 + 0.74 (VOT / PI (AO)). [VOT = intraocular pressure. PI – pulsatility index arteriae ophthalmic from Color Doppler ultrasonography.] IKT can be approximate calculate with mathematical formulas: IKT = 0:55 × BMI (kg / m2) + 0.16 × KTD (mmHg) - 0:18 x age (years) - 1.91. [KTD - diastolic blood pressure, BMI - Body master index] or: IKT = 16.95 x 0.39 x OSASW09 + BMI + 0.14 + TKS - 20.90. [OSASW095: width of the orbital arachnoid space at a distance of 9 mm behind the eyeball (nuclear magnetic resonance). BMI: Body Mass Index. TKS: mean arterial pressure]. Normal values of VPT are under 15 torr. The risk of increased intracranial pressure is above 20 torr. Under physiological conditions, there is intraocular pressure lower in about 5 torr than VPT. Conclusion: D-ODM is a useful screening method in the evaluation of IKT for hydrocephalus, brain tumors, cerebral hemorrhage after brain trauma and also in ocular diseases: Glaucoma, Ocular hypertension, orbitopathy (endocrine orbitopathy), ischemic / non-ischemic occlusion of blood vessels of the eye, indirect detection ICT carotid artery-cavernous fistula, amaurosis fugax, optic neuropathy. D-ODM is suitable for immediate evaluation of IKT, but is not suitable for continuous monitoring. As it can be repeated, it is useful for a patient suspected of having an increased ICT.

Článek online

Translaminar gradient and glaucoma

Čmelo, Jozef
Autor Autorita Center for neuro-ophthalmology, Bratislava

Czech and Slovak Ophthalmology. 2017 ; 73 (2) : 52-56.

Medvik
Zdroj

Objective: The cribriform plate is a threshold of the intraocular pressure (VOT) and of the intracranial pressure (IKT). The difference between the VOT and IKT is referred to as translaminar gradient (TLG). The goal was to evaluate the Glaucoma progression (visual field, fundus examination, HRT) with / without topical anti-glaucomatous therapy) in relation to the TLG. Patients and methods: the significance of TLG has been studied in two groups. I. Group: 57 patients diagnosed and treatment of Primary Open-Angle Glaucoma (PGOU), 10 patients with Ocular hypertension (OH), 7 patients with Normal-Tension Glaucoma (NTG), and 75 healthy without glaucoma. The examinations of TLG were carried out once and retrospectively. In II. group there were prospectively studied 14 patients with OH and 24 patients with newly detected PGOU without local therapy. The examinations were performed 4 times at intervals of 10 to 11 months. All tests included a basic eye examination, ORA tonometry, HRT examination, gonioscopy, Color Doppler sonography of blood vessels of the eye and orbit. Venous pulsation pressure (VPT) has been recorded by the Ophthalmodynamometer Meditron (D-ODM). In case of pontaneous retinal venous pulsation, VPT was considered as the same pressure as the VOT. The TLG was calculated with formula of Querfurth: ICT = 0.29 + 0.74 (VOT / PI (AO)). [PI(AO) – Pulsatility index of the Ophthalmic artery (AO)]. Results: I. group: TLG was in the control group without Glaucoma: 12.2 ± 2.0 torr. The NTG group: 9.0 ± 1.70 mm Hg. PGOU: 11.1 ± 1.91 mm Hg. OH: 12.6 ± 0.85 mm Hg. IKT alone does not show a significant relationship to the presence of glaucoma, ocular hypertension. II. Group: The average TLG in Ocular Hypertension (14 patients) has been 3.8 ± 1.2 torr. 2 patients (OH) had TLG 10 torr. and 15 torr. After 4 years in one of them (TLG = 15 torr.) there was recorded Glaucoma progression. In the PGOU group before antiglaucoma therapy, TLG was 15.0 ± 4.8 torr for all patients. After setting up local anti-glaucoma therapy and decreasing VOT, the TLG in 20 patients reduced to 3.6 ± 1.3 mm Hg. Conclusion: TLG showed a significant relationship to the Glaucoma progression. The risk of glaucomatous damage increases proportionally with increasing Translaminar gradient. Translaminar gradient can be use to refine the so-called. “Target VOT”. TLG has a role in ocular damage (ocular hypertension, glaucoma, vascular occlusion, optic neuropathy), intracranial damage, orbitopathy, selection of appropriate antiglaucomatous therapy.