Skip to main content
PMC home page
Transactions of the American Ophthalmological Society logoLink to Transactions of the American Ophthalmological Society
. 2001;99:241–252.

The effect of trabeculectomy on ocular hemodynamics.

L B Cantor 1
PMCID: PMC1359016  PMID: 11797313

Abstract

PURPOSE: To evaluate the effects of chronic reduction of intraocular pressure (IOP) on ocular hemodynamics. METHODS: Multisite, prospective evaluation of patients requiring trabeculectomy for treatment of glaucoma. Patients were recruited from the glaucoma service of 2 university hospitals. Patients were evaluated prior to surgery and at 3, 6, and 12 months after trabeculectomy. Color Doppler imaging was used to measure blood flow in the ophthalmic artery, central retinal artery, and short posterior ciliary arteries. Heidelberg retinal flowmetry was used to evaluate perfusion in the peripapillary and optic disc capillary beds. IOP was measured at baseline and at each study visit. RESULTS: There were highly significant reductions in IOP from presurgical baseline measures. At 3 months, mean IOP reduction was 17.1 mm Hg (62.3%; P < .001). At the 6- and 12-month evaluations, the mean IOP reductions were 15.7 mm Hg (57.3%) and 15.5 mm Hg (56.5%), respectively, P < .001. Despite the significant reduction in IOP, there were no significant differences in any ocular blood flow parameters before and after trabeculectomy. CONCLUSIONS: The findings of this study suggest that chronic reduction of IOP does not alter ocular blood flow and that IOP may be an independent risk factor for progression of glaucoma. These findings also suggest that the eye has the ability to autoregulate to chronically increased IOP over time and that additional studies evaluating the long-term effects of IOP changes are needed to further define this relationship.

Full Text

The Full Text of this article is available as a PDF (87.2 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alward W. L. The genetics of open-angle glaucoma: the story of GLC1A and myocilin. Eye (Lond) 2000 Jun;14(Pt 3B):429–436. doi: 10.1038/eye.2000.127. [DOI] [PubMed] [Google Scholar]
  2. Arend O., Harris A., Arend S., Remky A., Martin B. J. The acute effect of topical beta-adrenoreceptor blocking agents on retinal and optic nerve head circulation. Acta Ophthalmol Scand. 1998 Feb;76(1):43–49. doi: 10.1034/j.1600-0420.1998.760108.x. [DOI] [PubMed] [Google Scholar]
  3. Bohdanecka Z., Orgül S., Meyer A. B., Prünte C., Flammer J. Relationship between blood flow velocities in retrobulbar vessels and laser Doppler flowmetry at the optic disk in glaucoma patients. Ophthalmologica. 1999;213(3):145–149. doi: 10.1159/000027409. [DOI] [PubMed] [Google Scholar]
  4. Buhrmann R. R., Quigley H. A., Barron Y., West S. K., Oliva M. S., Mmbaga B. B. Prevalence of glaucoma in a rural East African population. Invest Ophthalmol Vis Sci. 2000 Jan;41(1):40–48. [PubMed] [Google Scholar]
  5. Butt Z., O'Brien C., McKillop G., Aspinall P., Allan P. Color Doppler imaging in untreated high- and normal-pressure open-angle glaucoma. Invest Ophthalmol Vis Sci. 1997 Mar;38(3):690–696. [PubMed] [Google Scholar]
  6. Butt Z., O'Brien C., McKillop G., Aspinall P., Allan P. Color Doppler imaging in untreated high- and normal-pressure open-angle glaucoma. Invest Ophthalmol Vis Sci. 1997 Mar;38(3):690–696. [PubMed] [Google Scholar]
  7. Carlsson A. M., Chauhan B. C., Lee A. A., Leblanc R. P. The effect of brimonidine tartrate on retinal blood flow in patients with ocular hypertension [corrected]. Am J Ophthalmol. 1999 Dec;128(6):697–701. doi: 10.1016/s0002-9394(99)00228-7. [DOI] [PubMed] [Google Scholar]
  8. Chung H. S., Harris A., Evans D. W., Kagemann L., Garzozi H. J., Martin B. Vascular aspects in the pathophysiology of glaucomatous optic neuropathy. Surv Ophthalmol. 1999 Jun;43 (Suppl 1):S43–S50. doi: 10.1016/s0039-6257(99)00050-8. [DOI] [PubMed] [Google Scholar]
  9. Chung H. S., Harris A., Kristinsson J. K., Ciulla T. A., Kagemann C., Ritch R. Ginkgo biloba extract increases ocular blood flow velocity. J Ocul Pharmacol Ther. 1999 Jun;15(3):233–240. doi: 10.1089/jop.1999.15.233. [DOI] [PubMed] [Google Scholar]
  10. Crick R. P., Vogel R., Newson R. B., Shipley M. J., Blackmore H., Palmer A., Bulpitt C. J. The visual field in chronic simple glaucoma and ocular hypertension; its character, progress, relationship to the level of intraocular pressure and response to treatment. Eye (Lond) 1989;3(Pt 5):536–546. doi: 10.1038/eye.1989.85. [DOI] [PubMed] [Google Scholar]
  11. Drance S. M., Douglas G. R., Wijsman K., Schulzer M., Britton R. J. Response of blood flow to warm and cold in normal and low-tension glaucoma patients. Am J Ophthalmol. 1988 Jan 15;105(1):35–39. doi: 10.1016/0002-9394(88)90118-3. [DOI] [PubMed] [Google Scholar]
  12. Duijm H. F., van den Berg T. J., Greve E. L. A comparison of retinal and choroidal hemodynamics in patients with primary open-angle glaucoma and normal-pressure glaucoma. Am J Ophthalmol. 1997 May;123(5):644–656. doi: 10.1016/s0002-9394(14)71077-3. [DOI] [PubMed] [Google Scholar]
  13. Evans D. W., Harris A., Garrett M., Chung H. S., Kagemann L. Glaucoma patients demonstrate faulty autoregulation of ocular blood flow during posture change. Br J Ophthalmol. 1999 Jul;83(7):809–813. doi: 10.1136/bjo.83.7.809. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Findl O., Strenn K., Wolzt M., Menapace R., Vass C., Eichler H. G., Schmetterer L. Effects of changes in intraocular pressure on human ocular haemodynamics. Curr Eye Res. 1997 Oct;16(10):1024–1029. doi: 10.1076/ceyr.16.10.1024.9024. [DOI] [PubMed] [Google Scholar]
  15. Fong D. S., Ferris F. L., 3rd, Davis M. D., Chew E. Y. Causes of severe visual loss in the early treatment diabetic retinopathy study: ETDRS report no. 24. Early Treatment Diabetic Retinopathy Study Research Group. Am J Ophthalmol. 1999 Feb;127(2):137–141. doi: 10.1016/s0002-9394(98)00309-2. [DOI] [PubMed] [Google Scholar]
  16. Gasser P., Flammer J. Blood-cell velocity in the nailfold capillaries of patients with normal-tension and high-tension glaucoma. Am J Ophthalmol. 1991 May 15;111(5):585–588. doi: 10.1016/s0002-9394(14)73703-1. [DOI] [PubMed] [Google Scholar]
  17. Gasser P., Flammer J., Guthauser U., Mahler F. Do vasospasms provoke ocular diseases? Angiology. 1990 Mar;41(3):213–220. doi: 10.1177/000331979004100306. [DOI] [PubMed] [Google Scholar]
  18. Gasser P., Meienberg O. Finger microcirculation in classical migraine. A video-microscopic study of nailfold capillaries. Eur Neurol. 1991;31(3):168–171. doi: 10.1159/000116670. [DOI] [PubMed] [Google Scholar]
  19. Graham S. L., Drance S. M., Wijsman K., Douglas G. R., Mikelberg F. S. Ambulatory blood pressure monitoring in glaucoma. The nocturnal dip. Ophthalmology. 1995 Jan;102(1):61–69. doi: 10.1016/s0161-6420(95)31053-6. [DOI] [PubMed] [Google Scholar]
  20. Groh M. J., Michelson G., Langhans M. J., Harazny J. Influence of age on retinal and optic nerve head blood circulation. Ophthalmology. 1996 Mar;103(3):529–534. doi: 10.1016/s0161-6420(96)30662-3. [DOI] [PubMed] [Google Scholar]
  21. Grunwald J. E., Piltz J., Hariprasad S. M., Dupont J., Maguire M. G. Optic nerve blood flow in glaucoma: effect of systemic hypertension. Am J Ophthalmol. 1999 May;127(5):516–522. doi: 10.1016/s0002-9394(99)00028-8. [DOI] [PubMed] [Google Scholar]
  22. Grunwald J. E., Riva C. E., Stone R. A., Keates E. U., Petrig B. L. Retinal autoregulation in open-angle glaucoma. Ophthalmology. 1984 Dec;91(12):1690–1694. doi: 10.1016/s0161-6420(84)34091-x. [DOI] [PubMed] [Google Scholar]
  23. Hamard P., Hamard H., Dufaux J., Quesnot S. Optic nerve head blood flow using a laser Doppler velocimeter and haemorheology in primary open angle glaucoma and normal pressure glaucoma. Br J Ophthalmol. 1994 Jun;78(6):449–453. doi: 10.1136/bjo.78.6.449. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Harris A., Arend O., Chung H. S., Kagemann L., Cantor L., Martin B. A comparative study of betaxolol and dorzolamide effect on ocular circulation in normal-tension glaucoma patients. Ophthalmology. 2000 Mar;107(3):430–434. doi: 10.1016/s0161-6420(99)00093-7. [DOI] [PubMed] [Google Scholar]
  25. Harris A., Sergott R. C., Spaeth G. L., Katz J. L., Shoemaker J. A., Martin B. J. Color Doppler analysis of ocular vessel blood velocity in normal-tension glaucoma. Am J Ophthalmol. 1994 Nov 15;118(5):642–649. doi: 10.1016/s0002-9394(14)76579-1. [DOI] [PubMed] [Google Scholar]
  26. James C. B. Effect of trabeculectomy on pulsatile ocular blood flow. Br J Ophthalmol. 1994 Nov;78(11):818–822. doi: 10.1136/bjo.78.11.818. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Javitt J. C., Schiffman R. M. Clinical success and quality of life with brimonidine 0.2% or timolol 0.5% used twice daily in glaucoma or ocular t hypertension: a randomized clinical trial. Brimonidine Outcomes Study Group I. J Glaucoma. 2000 Jun;9(3):224–234. doi: 10.1097/00061198-200006000-00005. [DOI] [PubMed] [Google Scholar]
  28. Jay J. L., Murray S. B. Early trabeculectomy versus conventional management in primary open angle glaucoma. Br J Ophthalmol. 1988 Dec;72(12):881–889. doi: 10.1136/bjo.72.12.881. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Joos K. M., Kay M. D., Pillunat L. E., Harris A., Gendron E. K., Feuer W. J., Steinwand B. E. Effect of acute intraocular pressure changes on short posterior ciliary artery haemodynamics. Br J Ophthalmol. 1999 Jan;83(1):33–38. doi: 10.1136/bjo.83.1.33. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Joos K. M., Pillunat L. E., Knighton R. W., Anderson D. R., Feuer W. J. Reproducibility of laser Doppler flowmetry in the human optic nerve head. J Glaucoma. 1997 Aug;6(4):212–216. [PubMed] [Google Scholar]
  31. Kagemann L., Harris A., Chung H. S., Evans D., Buck S., Martin B. Heidelberg retinal flowmetry: factors affecting blood flow measurement. Br J Ophthalmol. 1998 Feb;82(2):131–136. doi: 10.1136/bjo.82.2.131. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Kaiser H. J., Schoetzau A., Stümpfig D., Flammer J. Blood-flow velocities of the extraocular vessels in patients with high-tension and normal-tension primary open-angle glaucoma. Am J Ophthalmol. 1997 Mar;123(3):320–327. doi: 10.1016/s0002-9394(14)70127-8. [DOI] [PubMed] [Google Scholar]
  33. Kerr J., Nelson P., O'Brien C. A comparison of ocular blood flow in untreated primary open-angle glaucoma and ocular hypertension. Am J Ophthalmol. 1998 Jul;126(1):42–51. doi: 10.1016/s0002-9394(98)00074-9. [DOI] [PubMed] [Google Scholar]
  34. Kitazawa Y., Shirai H., Go F. J. The effect of Ca2(+) -antagonist on visual field in low-tension glaucoma. Graefes Arch Clin Exp Ophthalmol. 1989;227(5):408–412. doi: 10.1007/BF02172889. [DOI] [PubMed] [Google Scholar]
  35. Kniestedt C., Kammann M. T., Stürmer J., Gloor B. P. Dysgenetische Kammerwinkelveränderungen bei Patienten mit Glaukom oder Verdacht auf Glaukom aufgetreten vor dem 40. Lebensjahr. Klin Monbl Augenheilkd. 2000 Jun;216(6):377–387. doi: 10.1055/s-2000-10584. [DOI] [PubMed] [Google Scholar]
  36. Lachkar Y., Migdal C., Dhanjil S. Effect of brimonidine tartrate on ocular hemodynamic measurements. Arch Ophthalmol. 1998 Dec;116(12):1591–1594. doi: 10.1001/archopht.116.12.1591. [DOI] [PubMed] [Google Scholar]
  37. Langham M. E. Ocular blood flow and vision in healthy and glaucomatous eyes. Surv Ophthalmol. 1994 May;38 (Suppl):S161–S168. doi: 10.1016/0039-6257(94)90061-2. [DOI] [PubMed] [Google Scholar]
  38. MAGITOT A. L'atrophie optique du glaucome primaire; considerations neurovasculaires. Ann Ocul (Paris) 1953 May;186(5):385–414. [PubMed] [Google Scholar]
  39. Michelson G., Harazny J. Relationship between ocular pulse pressures and retinal vessel velocities. Ophthalmology. 1997 Apr;104(4):664–671. doi: 10.1016/s0161-6420(97)30254-1. [DOI] [PubMed] [Google Scholar]
  40. Michelson G., Langhans M. J., Groh M. J. Perfusion of the juxtapapillary retina and the neuroretinal rim area in primary open angle glaucoma. J Glaucoma. 1996 Apr;5(2):91–98. [PubMed] [Google Scholar]
  41. Michelson G., Schmauss B., Langhans M. J., Harazny J., Groh M. J. Principle, validity, and reliability of scanning laser Doppler flowmetry. J Glaucoma. 1996 Apr;5(2):99–105. [PubMed] [Google Scholar]
  42. Michelson G., Schmauss B. Two dimensional mapping of the perfusion of the retina and optic nerve head. Br J Ophthalmol. 1995 Dec;79(12):1126–1132. doi: 10.1136/bjo.79.12.1126. [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Minckler D. S., Spaeth G. L. Optic nerve damage in glaucoma. Surv Ophthalmol. 1981 Nov-Dec;26(3):128–148. doi: 10.1016/0039-6257(81)90061-8. [DOI] [PubMed] [Google Scholar]
  44. O'Brien C., Butt Z. Blood flow velocity in the peripheral circulation of glaucoma patients. Ophthalmologica. 1999;213(3):150–153. doi: 10.1159/000027410. [DOI] [PubMed] [Google Scholar]
  45. Phelps C. D., Corbett J. J. Migraine and low-tension glaucoma. A case-control study. Invest Ophthalmol Vis Sci. 1985 Aug;26(8):1105–1108. [PubMed] [Google Scholar]
  46. Phelps C. D., Corbett J. J. Migraine and low-tension glaucoma. A case-control study. Invest Ophthalmol Vis Sci. 1985 Aug;26(8):1105–1108. [PubMed] [Google Scholar]
  47. Pillunat L. E., Anderson D. R., Knighton R. W., Joos K. M., Feuer W. J. Autoregulation of human optic nerve head circulation in response to increased intraocular pressure. Exp Eye Res. 1997 May;64(5):737–744. doi: 10.1006/exer.1996.0263. [DOI] [PubMed] [Google Scholar]
  48. Pillunat L. E., Stodtmeister R., Wilmanns I., Christ T. Autoregulation of ocular blood flow during changes in intraocular pressure. Preliminary results. Graefes Arch Clin Exp Ophthalmol. 1985;223(4):219–223. doi: 10.1007/BF02174065. [DOI] [PubMed] [Google Scholar]
  49. Popovic V., Sjöstrand J. Long-term outcome following trabeculectomy: II Visual field survival. Acta Ophthalmol (Copenh) 1991 Jun;69(3):305–309. doi: 10.1111/j.1755-3768.1991.tb04819.x. [DOI] [PubMed] [Google Scholar]
  50. Quaranta L., Harris A., Donato F., Cassamali M., Semeraro F., Nascimbeni G., Gandolfo E., Quaranta C. A. Color Doppler imaging of ophthalmic artery blood flow velocity: a study of repeatability and agreement. Ophthalmology. 1997 Apr;104(4):653–658. doi: 10.1016/s0161-6420(97)30256-5. [DOI] [PubMed] [Google Scholar]
  51. Quaranta L., Manni G., Donato F., Bucci M. G. The effect of increased intraocular pressure on pulsatile ocular blood flow in low tension glaucoma. Surv Ophthalmol. 1994 May;38 (Suppl):S177–S182. doi: 10.1016/0039-6257(94)90064-7. [DOI] [PubMed] [Google Scholar]
  52. Quigley H. A., Hohman R. M., Addicks E. M., Massof R. W., Green W. R. Morphologic changes in the lamina cribrosa correlated with neural loss in open-angle glaucoma. Am J Ophthalmol. 1983 May;95(5):673–691. doi: 10.1016/0002-9394(83)90389-6. [DOI] [PubMed] [Google Scholar]
  53. Quigley H. A., Nickells R. W., Kerrigan L. A., Pease M. E., Thibault D. J., Zack D. J. Retinal ganglion cell death in experimental glaucoma and after axotomy occurs by apoptosis. Invest Ophthalmol Vis Sci. 1995 Apr;36(5):774–786. [PubMed] [Google Scholar]
  54. Rankin S. J., Walman B. E., Buckley A. R., Drance S. M. Color Doppler imaging and spectral analysis of the optic nerve vasculature in glaucoma. Am J Ophthalmol. 1995 Jun;119(6):685–693. doi: 10.1016/s0002-9394(14)72771-0. [DOI] [PubMed] [Google Scholar]
  55. Riva C. E., Harino S., Petrig B. L., Shonat R. D. Laser Doppler flowmetry in the optic nerve. Exp Eye Res. 1992 Sep;55(3):499–506. doi: 10.1016/0014-4835(92)90123-a. [DOI] [PubMed] [Google Scholar]
  56. Rojanapongpun P., Drance S. M., Morrison B. J. Ophthalmic artery flow velocity in glaucomatous and normal subjects. Br J Ophthalmol. 1993 Jan;77(1):25–29. doi: 10.1136/bjo.77.1.25. [DOI] [PMC free article] [PubMed] [Google Scholar]
  57. Rojanapongpun P., Drance S. M. Velocity of ophthalmic arterial flow recorded by Doppler ultrasound in normal subjects. Am J Ophthalmol. 1993 Feb 15;115(2):174–180. doi: 10.1016/s0002-9394(14)73921-2. [DOI] [PubMed] [Google Scholar]
  58. Salmon J. F., Mermoud A., Ivey A., Swanevelder S. A., Hoffman M. The prevalence of primary angle closure glaucoma and open angle glaucoma in Mamre, western Cape, South Africa. Arch Ophthalmol. 1993 Sep;111(9):1263–1269. doi: 10.1001/archopht.1993.01090090115029. [DOI] [PubMed] [Google Scholar]
  59. Sarfarazi M., Stoilov I. Molecular genetics of primary congenital glaucoma. Eye (Lond) 2000 Jun;14(Pt 3B):422–428. doi: 10.1038/eye.2000.126. [DOI] [PubMed] [Google Scholar]
  60. Schmidt K. G., Dick B., von Rückmann A., Pillunat L. E. Okuläre Pulsamplitude und lokale Karboanhydrasehemmung. Ophthalmologe. 1997 Sep;94(9):659–664. doi: 10.1007/s003470050179. [DOI] [PubMed] [Google Scholar]
  61. Schumann J., Orgül S., Gugleta K., Dubler B., Flammer J. Interocular difference in progression of glaucoma correlates with interocular differences in retrobulbar circulation. Am J Ophthalmol. 2000 Jun;129(6):728–733. doi: 10.1016/s0002-9394(99)00481-x. [DOI] [PubMed] [Google Scholar]
  62. Schwartz B., Kern J. Age, increased ocular and blood pressures, and retinal and disc fluorescein angiogram. Arch Ophthalmol. 1980 Nov;98(11):1980–1986. doi: 10.1001/archopht.1980.01020040832007. [DOI] [PubMed] [Google Scholar]
  63. Tielsch J. M., Katz J., Sommer A., Quigley H. A., Javitt J. C. Hypertension, perfusion pressure, and primary open-angle glaucoma. A population-based assessment. Arch Ophthalmol. 1995 Feb;113(2):216–221. doi: 10.1001/archopht.1995.01100020100038. [DOI] [PubMed] [Google Scholar]
  64. Trible J. R., Sergott R. C., Spaeth G. L., Wilson R. P., Katz L. J., Moster M. R., Schmidt C. M. Trabeculectomy is associated with retrobulbar hemodynamic changes. A color Doppler analysis. Ophthalmology. 1994 Feb;101(2):340–351. doi: 10.1016/s0161-6420(13)31332-3. [DOI] [PubMed] [Google Scholar]
  65. Turaçli M. E., Ozden R. G., Gürses M. A. The effect of betaxolol on ocular blood flow and visual fields in patients with normotension glaucoma. Eur J Ophthalmol. 1998 Apr-Jun;8(2):62–66. doi: 10.1177/112067219800800202. [DOI] [PubMed] [Google Scholar]
  66. Wilensky J. T. Diurnal variations in intraocular pressure. Trans Am Ophthalmol Soc. 1991;89:757–790. [PMC free article] [PubMed] [Google Scholar]
  67. Williamson T. H., Lowe G. D., Baxter G. M. Influence of age, systemic blood pressure, smoking, and blood viscosity on orbital blood velocities. Br J Ophthalmol. 1995 Jan;79(1):17–22. doi: 10.1136/bjo.79.1.17. [DOI] [PMC free article] [PubMed] [Google Scholar]
  68. Zucca I., Tanda A., Piras V., Mulas S., Mureddu E., Lecis F., Sulis R., Palmas M. C., Fossarello M., Serra A. The influence of diabetes mellitus on primary open angle glaucoma perimetry. Acta Ophthalmol Scand Suppl. 1997;(224):49–50. doi: 10.1111/j.1600-0420.1997.tb00477.x. [DOI] [PubMed] [Google Scholar]

Articles from Transactions of the American Ophthalmological Society are provided here courtesy of American Ophthalmological Society

RESOURCES