Elsevier

Ophthalmology

Volume 115, Issue 5, May 2008, Pages 763-768
Ophthalmology

Original article
Cerebrospinal Fluid Pressure Is Decreased in Primary Open-angle Glaucoma

https://doi.org/10.1016/j.ophtha.2008.01.013Get rights and content

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.

Section snippets

Patient Selection

The study was approved by the Mayo Clinic Institutional Review Board. This was a retrospective study of medical records of patients with and without POAG who had undergone lumbar puncture (LP) with measurement of CSF pressure and CSF analysis. A computerized search of all patients who underwent LP at the Mayo Clinic between 1997 and 2006 was used as the initial data set. This list was cross-referenced by International Classification of Diseases 9 code to identify all patients who were diagnosed

Results

Between 1997 and 2006, a 10-year period, 31,786 subjects underwent LP at the Mayo Clinic. Of this number, 28 met criteria for inclusion into the POAG group and 49 subjects met criteria for the control group. Of 116 subjects diagnosed with POAG, 88 were excluded for the following reasons: failure to meet the definition of POAG (n = 47), no recorded CSF pressure measurement (n = 37), abnormal CSF analysis results (n = 2), and past medical history or past surgical history (n = 2). Of 556 potential

Discussion

In this retrospective analysis, the authors found that mean CSF pressure was 33% lower in subjects with POAG (9.2 mmHg) compared with that of nonglaucomatous controls (13.0 mmHg; P<0.00005). These data suggest that the translaminar pressure difference is influenced by both IOP and the CSF pressure in patients with POAG. The measured CSF pressure difference between POAG subjects and controls in this study is similar to the mean IOP difference between POAG and controls found in many

Acknowledgment

The authors thank Sandra Stinnett, PhD, for help with statistical analysis.

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    • Cited by (0)

    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.

    †

    Deceased.

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    Copyright © 2008 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.