Cerebrospinal Fluid Pressure Is Decreased in Primary Open-angle Glaucoma
Received 1 August 2007; received in revised form 11 January 2008; accepted 14 January 2008.
Purpose
To compare cerebrospinal fluid (CSF) pressure in patients with primary open-angle glaucoma (POAG) with that in nonglaucomatous patients.
Design
Case–control study.
Participants
Thirty-one thousand, seven hundred and eighty-six subjects underwent lumbar puncture (LP) between 1996 and 2007 at the Mayo Clinic, Rochester, Minnesota. Of these, 28 patients who had POAG and 49 patients who did not have POAG were analyzed.
Methods
Retrospective review of medical records. Comparison of the 2 groups and factors associated with CSF pressure were analyzed by univariate and multivariate analyses.
Main Outcome Measures
Demographics (age and gender), medical history, medication use, indication for LP, intraocular pressure (IOP), optic disc cup-to-disc ratio, visual field assessment, and CSF pressure.
Results
The mean CSF pressure ± standard deviation was 13.0±4.2 mmHg in nonglaucoma patients and 9.2±2.9 mmHg in POAG patients (P<0.00005). The CSF pressure was lower in POAG patients regardless of indication for LP or age. Linear regression analysis showed that cup-to-disc ratio correlated independently with IOP (P<0.0001), CSF pressure (P<0.0001), and the translaminar pressure difference (P<0.0001). Multivariate analysis demonstrated that larger cup-to-disc ratio (P<0.0001) was associated with lower CSF pressure.
Conclusions
Cerebrospinal fluid pressure is significantly lower in POAG patients compared with that in nonglaucomatous controls. These data support the notion that CSF pressure may play an important contributory role in the pathogenesis of POAG.
1Duke University Eye Center, Durham, North Carolina.
2Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
Correspondence to John P. Berdahl, MD, Duke University Medical Center (DUMC), Box 3802, Durham, NC 27710.
Manuscript no. 2007-1002.
Supported by Research to Prevent Blindness, Inc., New York, New York, and the Barkhouser Glaucoma Research Fund (RRA), Durham, North Carolina.
No conflicting relationship exists for any author.
ABSTRACT