NYMC Faculty Publications

Valsalva Manoeuver, Intra-Ocular Pressure, Cerebrospinal Fluid Pressure, Optic Disc Topography: Beijing Intracranial and Intra-Ocular Pressure Study

Author Type(s)

Faculty

DOI

10.1111/aos.12263

Journal Title

Acta Ophthalmologica

First Page

475

Last Page

480

Document Type

Article

Publication Date

9-1-2014

Department

Ophthalmology

Keywords

Adolescent, Adult, Cerebrospinal Fluid Pressure, China, Female, Glaucoma, Open-Angle, Humans, Intraocular Pressure, Male, Microscopy, Confocal, Middle Aged, Optic Disk, Optic Nerve Diseases, Tonometry, Ocular, Valsalva Maneuver, Young Adult

Disciplines

Medicine and Health Sciences

Abstract

PURPOSE: To assess whether a Valsalva manoeuver influences intra-ocular pressure (IOP), cerebrospinal fluid pressure (CSF-P) and, by a change in the trans-laminar cribrosa pressure difference, optic nerve head morphology.

METHODS: In the first part of the study, 20 neurological patients (study group 'A') underwent measurement of IOP and lumbar CSF-P measurement in a lying position before and during a Valsalva manoeuver. In the second study part, 20 healthy subjects (study group 'B') underwent ocular tonometry and confocal scanning laser tomography of the optic nerve head before and during a Valsalva manoeuver.

RESULTS: During the Valsalva manoeuver in study group 'A', the increase in CSF-P by 10.5 ± 2.7 mmHg was significantly (p < 0.001) higher than the increase in IOP by 1.9 ± 2.4 mmHg. The change in CSF-P was not significantly (p = 0.61) correlated with the change in IOP. During the Valsalva manoeuver in study group 'B', IOP increased by 4.5 ± 4.2 mmHg and optic cup volume (p < 0.001), cup/disc area ratio (p = 0.02), cup/disc diameter ratio (p = 0.03) and maximum optic cup depth (p = 0.01) significantly decreased, while neuroretinal rim volume (p = 0.005) and mean retinal nerve fibre layer thickness (p = 0.02) significantly increased.

CONCLUSIONS: The Valsalva manoeuver-associated short-term increase in CSF-P was significantly larger than a simultaneous short-term increase in IOP. It led to a Valsalva manoeuver-associated decrease or reversal of the trans-laminar cribrosa pressure difference, which was associated with a change in the three-dimensional optic nerve head morphology: optic cup-related parameters decreased and neuroretinal rim-related parameters enlarged. These findings may be of interest for the pathogenesis of glaucomatous optic neuropathy.

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