Abstract
Despite glaucoma being the second leading cause of blindness globally, its pathogenesis remains incompletely understood. Although intraocular pressure (IOP) contributes to glaucoma, and reducing IOP slows progress of the disease, some patients progress despite normal IOP (NTG). Glaucomatous damage causes characteristic cupping of the optic nerve where it passes through the lamina cribrosa. There is evidence that cerebrospinal fluid (CSF) within the optic nerve sheath has a different composition from CSF surrounding the brain. Furthermore, fluctuations in CSF flow into the optic nerve sheath may be reduced by trabeculae within the sheath, and on standing intracranial pressure (ICP) within the sheath is stabilised at around 3 mmHg due to orbital pressure. Blood pressure has been linked both to glaucoma and ICP. These facts have led some to conclude that ICP does not play a role in glaucoma. However, according to stress formulae and Laplace’s Law, stress within the lamina cribrosa is dependent on the forces on either side of it, (IOP and ICP), and its thickness. On lying flat at night, ICP between the brain and optic nerve sheath should equalise. Most evidence suggests ICP is lower in glaucoma than in control groups, and that the lamina cribrosa is thinner and more posteriorly displaced in glaucoma. Subjects who have had ICP reduced have developed signs of glaucoma. This review finds most evidence supports a role for low ICP in the pathogenesis of glaucoma. Caffeine, theophylline and vitamin A may increase ICP, and could be new candidates for an oral treatment.
摘要
青光眼为全球第二大致盲眼病, 其发病机制仍不完全清楚。尽管眼内压 (IOP) 为青光眼发病的主要因素, 降低IOP可减缓病情发展, 但有些患者尽管IOP正常仍可发展为青光眼 (NTG), 导致穿过筛板处的视神经特征性的视杯改变。有证据表明, 视神经鞘内的脑脊液 (CSF) 与大脑周围的CSF中的成分不同。此外, 鞘内的小梁可以减少CSF流入视神经鞘, 从而减少IOP的波动, 鞘内颅内压 (ICP) 在静止时由于眼眶压可稳定在3mmHg左右。血压与青光眼和ICP有关。这些事实可以得出结论: ICP与青光眼的发病作用不大。
然而, 根据应力公式和拉普拉斯定律, 筛板内部的应力取决于其两侧的力量 (眼压和颅内压) 及其厚度。夜间平躺时, 大脑和视神经鞘之间的ICP应是均衡的。大多数证据表明青光眼患者的ICP低于对照组, 并且青光眼患者的筛板更薄且更后移, 降低ICP后, 受试者出现了青光眼症状。
本综述发现大多数证据支持低颅内压在青光眼发病中的作用。咖啡因、茶碱和维生素A有增加颅内压的可能, 因此也可能成为新的候选口服药物。
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Baneke, A.J., Aubry, J., Viswanathan, A.C. et al. The role of intracranial pressure in glaucoma and therapeutic implications. Eye 34, 178–191 (2020). https://doi.org/10.1038/s41433-019-0681-y
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