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[Normal-pressure glaucoma: a hypothesis of pathogenesis].

A P Nesterov, Zh Iu Aliab'eva, A V Lavrent'ev

    Vestnik Oftalmologii
    |September 19, 2003
    PubMed
    Summary
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    Normal pressure glaucoma (NPG) and primary open-angle glaucoma (POAG) are distinct conditions. NPG often involves cerebrovascular issues, requiring both ophthalmologist and neurologist collaboration for diagnosis and treatment.

    Area of Science:

    • Ophthalmology
    • Neurology
    • Vascular Biology

    Background:

    • Normal pressure glaucoma (NPG) and primary open-angle glaucoma (POAG) are heterogeneous optic neuropathies.
    • Risk factors and pathogenesis differ between NPG and POAG, though some overlap exists, particularly with moderately high IOP in POAG.
    • A significant portion of NPG cases may be misdiagnosed as pseudo-normal pressure glaucoma.

    Purpose of the Study:

    • To investigate the specific features and underlying pathologies of Normal Pressure Glaucoma (NPG).
    • To explore the role of cerebrovascular pathology in the pathogenesis of NPG.
    • To emphasize the need for multidisciplinary involvement in NPG diagnosis and management.

    Main Methods:

    • Analysis of clinical features and risk factors in NPG patients.

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  • Evaluation of cerebrovascular status, including occlusive processes and collateral circulation.
  • Assessment of vascular endothelium function and cerebral perfusion reserve.

    • Main Results:

    • NPG-specific features are frequently linked to insufficient cerebral blood circulation, including occlusive vascular processes and endothelial dysfunction.
    • Ischemia in visual pathways (e.g., corpus bigeminum, corpus geniculate laterale) reduces neurotrophin supply to retinal ganglion cells, promoting apoptosis.
    • Optic nerve head excavation in NPG is influenced by optic nerve disk area and mechanical factors, in addition to intraocular pressure (IOP).

    Conclusions:

    • Cerebrovascular pathology is a significant preconditioning factor for a substantial share of NPG cases.
    • The interplay between IOP, optic nerve disk size, and mechanical forces contributes to optic nerve damage in NPG.
    • Collaborative diagnosis and treatment involving ophthalmologists and neurologists are crucial for managing NPG patients.