Valsalva manoeuver, intra‐ocular pressure, cerebrospinal fluid pressure, optic disc topography: Beijing intracranial and intra‐ocular pressure study. (11th September 2013)

• Record Type: Journal Article
• Authors: Zhang, Zheng; Wang, Xiaolei; Jonas, Jost B.; Wang, Huaizhou; Zhang, Xiaojun; Peng, Xiaoxia; Ritch, Robert; Tian, Guohong; Yang, Diya; Li, Lei; Li, Junfa; Wang, Ningli
• Is Part Of: Acta ophthalmologica. Volume 92:Number 6(2014)
• Page Start: e475
• Page End: e480
• Publication Date: 2013-09-11
• Subjects: Ophthalmology -- Periodicals; 617.7005
• DOI: 10.1111/aos.12263
• Languages: English
• ISSNs: 1755-375X

Abstract

<abstract abstract-type="main" id="aos12263-abs-0001"> <title>Abstract</title> <sec id="aos12263-sec-0001" sec-type="section"> <title>Purpose</title> <p>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.</p> </sec> <sec id="aos12263-sec-0002" sec-type="section"> <title>Methods</title> <p>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.</p> </sec> <sec id="aos12263-sec-0003" sec-type="section"> <title>Results</title> <p>During the Valsalva manoeuver in study group 'A', the increase in CSF‐P by 10.5 ± 2.7 mmHg was significantly (p<italic> </italic><<italic> </italic>0.001) higher than the increase in IOP by 1.9 ± 2.4 mmHg. The change in CSF‐P was not significantly (p<italic> </italic>=<italic> </italic>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<italic> </italic><<italic> </italic>0.001), cup/disc area ratio (p<italic> </italic>=<italic> </italic>0.02), cup/disc diameter ratio (p<italic> </italic>=<italic> </italic>0.03) and maximum optic cup depth (p<italic> </italic>=<italic> </italic>0.01) significantly decreased, while neuroretinal rim volume (p<italic> </italic>=<italic> </italic>0.005) and mean retinal nerve fibre layer thickness (p<italic> </italic>=<italic> </italic>0.02) significantly increased.</p> </sec> <sec id="aos12263-sec-0004" sec-type="section"> <title>Conclusions</title> <p>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.</p> </sec> </abstract>