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Objective: To assess the relation between ocular per- Student t test was used to evaluate differences between con-
fusion pressure and blood flow velocity in the central reti- trols and subjects with vasospasm.
nal artery in patients with acral vasospasm.
Results: The mean ± SD ocular perfusion pressure was
Subjects and Methods: Eighteen otherwise healthy sub- 42.0 ± 7.4 mm Hg in the group with vasospasm and
jects with acral vascular dysregulation, as demonstrated 47.1 ± 6.5 mm Hg in the control group (P = .04). In the
by nail-fold capillaroscopy, and 18 age- and sex-matched subjects with vasospasm, the peak systolic and end-
healthy volunteers without vasospasm were recruited. Af- diastolic velocities and the resistivity index of the cen-
ter subjects had rested for 20 minutes in a supine posi- tral retinal artery correlated significantly with the mean
tion, intraocular pressure and blood flow velocity in the ocular perfusion pressure (R = 0.49, P = .04; R = 0.58,
central retinal artery were determined by applanation to- P = .01; and R = −0.67, P = .002, respectively). Such cor-
nometry and color Doppler imaging, respectively. The peak relations were not found in the control group.
systolic velocity, end-diastolic velocity, and resistivity in-
dex were assessed. Correlations between the mean ocu- Conclusion: An altered blood flow regulation is sug-
lar perfusion pressure (2/3 3 [2/3 × diastolic blood pres- gested in the ocular circulation of patients with acral va-
sure + 1/3 3 systolic blood pressure] − intraocular pressure) sospasm.
and blood flow velocities in the central retinal artery were
determined by the Pearson linear correlation factor. The Arch Ophthalmol. 1999;117:1359-1362
G
LAUCOMA IS a progres- Such a dysregulation would be equiva-
sive optic neuropathy in- lent to a lack of autoregulation.
volving characteristic The pathogenesis of the vasospastic
structural changes of the syndrome is not clear. Some evidence8
optic nerve and charac- suggests that the local hormone endo-
teristic visual field defects.1 An increased thelin 1 plays an important role. The
intraocular pressure (IOP) is the risk fac- clinical picture depends on the location
tor most often associated with glaucoma- of the spasms.9,10 Typical manifestations
tous optic neuropathy. Ample evidence2 include variant angina, the Raynaud
suggests, however, that an increased IOP syndrome, migraine, and systemic
cannot be the only pathogenic factor in hypotension.11 The vascular crisis can
glaucomatous optic neuropathy. Among be provoked by many factors such as
other variables that might be involved in emotions, exposure to nicotine, and
the pathogenesis of glaucoma, vascular risk exposure to cold. The most accurate
factors are the most extensively studied.3 method to verify vasospasms is the
In particular, a vascular dysregulation that direct observation of capillaries in the
leads to local vasospasm or impaired au- nail-fold skin (capillaroscopy), viewed
toregulation has been advocated as a pos- under indirect illumination after the
sible contributing factor in the cause of skin has been made transparent by the
glaucoma.4-6 Vasospasms are normally de- application of a drop of oil.11
fined as inappropriate vasoconstrictions Vasospasms in the retinal vessels
without recognizable anatomic causes. A have been observed in patients with
vasospastic diathesis might be expressed unstable primary angina and those with
From the University Eye Clinic, not only by a local vasoconstriction but migraine. 12 How such dysregulative
Basel, Switzerland. also by an inappropriate vasodilation.7 phenomena might lead to structural
ischemic lesions is not well understood. Indeed, most central serous chorioretinopathy. 15 Therefore, an
patients with a vasospastic diathesis do not have any assessment of blood flow regulatory mechanisms in
disease. Vascular dysregulation, however, has been the ocular circulation of subjects with vasospasm is
advocated to represent a possible risk factor in various warranted. This study was done to evaluate the rela-
ocular conditions, including glaucoma,2 retinal venous tion between retinal blood flow velocity measurements
occlusion,13 acute ischemic optic neuropathy,14 and and ocular perfusion pressure.
3.6
0.80
RESULTS
Resistivity Index
0.76
The mean ± SD age of the 18 subjects with vasospasm was
35 ± 11 years and of the 18 control subjects was 36 ± 10 0.72
years; each group was composed of 16 women and 2 men.
Hemodynamic measurements have been outlined in 0.68