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Update in intracranial pressure evaluation methods and translaminar pressure gradient role in glaucoma

机译:颅内压评估方法的更新和跨层压梯度在青光眼中的作用

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摘要

Glaucoma is one of the leading causes of blindness worldwide. Historically, it has been considered an ocular disease primary caused by pathological intraocular pressure (IOP). Recently, researchers have emphasized intracranial pressure (ICP), as translaminar counter pressure against IOP may play a role in glaucoma development and progression. It remains controversial what is the best way to measure ICP in glaucoma. Currently, the ‘gold standard’ for ICP measurement is invasive measurement of the pressure in the cerebrospinal fluid via lumbar puncture or via implantation of the pressure sensor into the brains ventricle. However, the direct measurements of ICP are not without risk due to its invasiveness and potential risk of intracranial haemorrhage and infection. Therefore, invasive ICP measurements are prohibitive due to safety needs, especially in glaucoma patients. Several approaches have been proposed to estimate ICP non-invasively, including transcranial Doppler ultrasonography, tympanic membrane displacement, ophthalmodynamometry, measurement of optic nerve sheath diameter and two-depth transcranial Doppler technology. Special emphasis is put on the two-depth transcranial Doppler technology, which uses an ophthalmic artery as a natural ICP sensor. It is the only method which accurately and precisely measures absolute ICP values and may provide valuable information in glaucoma.
机译:青光眼是全球失明的主要原因之一。从历史上看,它被认为是由病理性眼内压(IOP)引起的主要眼病。最近,研究人员强调颅内压(ICP),因为针对IOP的跨层反压可能在青光眼的发生和发展中起作用。在青光眼中测量ICP的最佳方法仍是有争议的。当前,ICP测量的“黄金标准”是通过腰穿或通过将压力传感器植入脑室来侵入性测量脑脊液中的压力。但是,由于ICP具有侵袭性以及颅内出血和感染的潜在风险,因此直接测量ICP并非没有风险。因此,由于安全需要,侵入性ICP测量是被禁止的,尤其是在青光眼患者中。已经提出了几种非侵入性地估计ICP的方法,包括经颅多普勒超声检查,鼓膜移位,眼肌测力,视神经鞘管直径的测量和两次经颅多普勒技术。特别强调的是两深度经颅多普勒技术,该技术使用眼科动脉作为天然ICP传感器。它是唯一能够准确,准确地测量ICP绝对值并可以提供青光眼有价值信息的方法。

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