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Age-Dependent Variation of Lamina Cribrosa Displacement During the Standardized Valsalva Maneuver.

ABSTRACT: Based on biomechanical theory, lamina cribrosa (LC) displacement, the key component of progressive glaucomatous change, is presumed to be dependent on intraocular pressure (IOP) as well as tissue stiffness of LC. In the performance of the Valsalva maneuver, both IOP and cerebrospinal fluid pressure can increase. The present study investigated the age-dependent variation of LC displacement during the standardized Valsalva maneuver in healthy subjects. Sixty-three (63) eyes (age range: 20-76 years) were prospectively underwent IOP measurement and Cirrus HD-OCT optic disc scans before and during the standardized Valsalva maneuver. During the standardized Valsalva maneuver, the IOP significantly increased from 13.2?±?2.9?mmHg to 18.6?±?5.2?mmHg (P?

SUBMITTER: Kim YW

PROVIDER: S-EPMC6491605 | biostudies-literature | 2019 Apr

REPOSITORIES: biostudies-literature

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Age-Dependent Variation of Lamina Cribrosa Displacement During the Standardized Valsalva Maneuver.

Kim Yong Woo YW Lee Dong Hyun DH Lim Hyung Bin HB Oh Baek-Lok BL Kim Young Kook YK Girard Michael J A MJA Mari Jean Martial JM Park Ki Ho KH Jeoung Jin Wook JW

Scientific reports 20190430 1

Based on biomechanical theory, lamina cribrosa (LC) displacement, the key component of progressive glaucomatous change, is presumed to be dependent on intraocular pressure (IOP) as well as tissue stiffness of LC. In the performance of the Valsalva maneuver, both IOP and cerebrospinal fluid pressure can increase. The present study investigated the age-dependent variation of LC displacement during the standardized Valsalva maneuver in healthy subjects. Sixty-three (63) eyes (age range: 20-76 years ...[more]

PMID: 31040379

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Human lamina cribrosa insertion and age.

Project description:PurposeTo test the hypothesis that in healthy human eyes the lamina cribrosa (LC) insertion into the pia mater increases with age.MethodsThe optic nerve heads (ONHs) of donor eyes fixed at either 5 or 50 mm Hg of IOP were sectioned, stained, and imaged under bright- and dark-field conditions. A 3-dimensional (3D) model of each ONH was reconstructed. From the 3D models we measured the area of LC insertion into the peripapillary scleral flange and into the pia, and computed the total area of insertion and fraction of LC inserting into the pia. Linear mixed effect models were used to determine if the measurements were associated with age or IOP.ResultsWe analyzed 21 eyes from 11 individuals between 47 and 91 years old. The LC inserted into the pia in all eyes. The fraction of LC inserting into the pia (2.2%-29.6%) had a significant decrease with age (P = 0.049), which resulted from a nonsignificant increase in the total area of LC insertion (P = 0.41) and a nonsignificant decrease in the area of LC insertion into the pia (P = 0.55). None of the measures was associated with fixation IOP (P values 0.44-0.81). Differences between fellow eyes were smaller than differences between unrelated eyes.ConclusionsThe LC insertion into the pia mater is common in middle-aged and older eyes, and does not increase with age. The biomechanical and vascular implications of the LC insertion into the pia mater are not well understood and should be investigated further.

| S-EPMC3466065 | biostudies-literature

Relationship of Corneal Hysteresis and Anterior Lamina Cribrosa Displacement in Glaucoma.

Project description:PurposeTo investigate the relationship between corneal hysteresis (CH) and anterior lamina cribrosa surface (ALCS) displacement over time in a cohort of patients with glaucoma.DesignProspective observational case series.MethodsIn this study, 147 eyes from 96 glaucoma or glaucoma suspect patients were followed for a mean of 3.5 years and 7.9 visits. Baseline CH measurements were obtained using the Ocular Response Analyzer (ORA; Reichert Ophthalmic Instruments Inc, Depew, New York, USA). The mean anterior lamina cribrosa surface depth (ALCSD) and choroidal thickness were by automated segmentation of spectral-domain optical coherence tomography (SD-OCT) scans. The rate of change of ALCSD was calculated using linear mixed effects models. Relationship between baseline CH and follow-up ALCSD rate of change was adjusted for confounding factors, including age, intraocular pressure (IOP), and choroidal thickness.ResultsThe mean baseline CH was 9.4 mm Hg (95% confidence interval [CI] 9.1-9.7). Overall, the ALCS was displaced posteriorly at a rate of 0.78 μm/y (95% CI -1.82, 0.26). Seventeen eyes (11.5%) showed a significant posterior displacement of ALCS, whereas 22 eyes (15.0%) showed a significant anterior displacement of ALCS. The choroidal thickness thinned at a rate of -1.09 μm/y during the follow-up (P = .001). Multivariable mixed modeling showed that choroidal thinning, lower IOP change, and lower corneal hysteresis were significantly associated with posterior ALCS displacement over time (P = .034, P = .037, and P = .048). Each 1 mm lower CH was associated with 0.66 μm/y posterior displacement of the ALCS.ConclusionsLower corneal hysteresis was significantly associated with posterior displacement of the anterior lamina cribrosa over time. These data provide additional support for lower corneal hysteresis being a risk factor for glaucoma progression.

| S-EPMC7113091 | biostudies-literature

Valsalva maneuver barrier mouthpiece during upper endoscopy.

Project description: Not available

| S-EPMC7666541 | biostudies-literature

Lamina cribrosa pore movement during acute intraocular pressure rise.

Project description:PurposeTo assess changes in the position of lamina cribrosa pores (LCPs) induced by acute intraocular pressure (IOP) elevation.MethodsA prospective observational study. Acute angle-closure suspects who underwent the 2-hour dark room prone provocative test (DRPPT) were included. At baseline and within 5 min after the DRPPT end, tonometry, fundus photography and optical coherence tomography were performed. Optic disc photos taken before and after the DRPPT were aligned and moving distance of each visible LCP was measured (LCPMD).Results38 eyes from 27 participants (age: 52.5±10.8 years) were included. The IOP rose from 16.7±3.2 mm Hg at baseline to 23.9±4.3 mm Hg at the DRPPT end. The mean lateral LCPMD was 28.1±14.6 µm (range: 5.0-77.2 µm), which increased with higher IOP rise (p=0.01) and deeper optic cup (p=0.02) in multivariate analysis. The intralamina range and SD of the LCPMD increased with younger age (p=0.01 and p=0.02, respectively) and with wider optic cup (p=0.01 and p=0.02, respectively). The LCP movements were headed to the superior direction in 12 (33%) eyes, inferior direction in 10 (28%) eyes, temporal direction in 9 (25%) eyes, and nasal direction in 5 (14%) eyes.ConclusionsIOP rise is associated with LCP movements in the frontal plane, which are more pronounced with higher IOP rise and deeper optic cup. The intralamina variability in the IOP rise-associated LCPMD increased with younger age and wider optic cup. IOP variation-associated lateral LCP movements may be of interest to elucidate glaucomatous optic nerve damage.

| S-EPMC7286041 | biostudies-literature

Focal lamina cribrosa defects are not associated with steep lamina cribrosa curvature but with choroidal microvascular dropout.

Project description:Focal lamina cribrosa (LC) defects have been found to play an important role in the development and progression of glaucomatous optic neuropathy. However, the mechanism of generation of focal LC defects is largely unknown. This cross-sectional study was performed to investigate LC curvature and the frequency of parapapillary choroidal microvascular dropout (MvD) in glaucomatous eyes with focal LC defects. This study was conducted by a retrospective review of patients with primary open-angle glaucoma (POAG) included in an ongoing prospective study being performed at the Seoul National University Bundang Hospital (Investigating Glaucoma Progression Study). A total of 118 eyes of 118 patients with POAG, 59 with and 59 without focal LC defects, with eyes matched by age, axial length, and severity of visual field (VF) damage were included. Posterior LC bowing was assessed by calculating LC curvature index (LCCI), as the inflection of a curve representing a section of the LC, on the optic nerve head images obtained by enhanced-depth-imaging (EDI) spectral-domain optical coherence tomography (OCT). MvD was detected by OCT angiography. LCCI and MvD frequency were compared between eyes with and without focal LC defects. Mean LCCI was significantly smaller than in eyes with than without focal LC defects (9.75 ± 1.29 vs. 11.25 ± 1.39, P < 0.001). MvD was significantly more frequent in eyes with than without focal LC defects (84.7% vs. 49.2%, P < 0.001). MvD in eyes with focal LC defects showed a strong topographic correlation with the focal LC defects. These findings suggest that focal LC defects may primarily result from vascular factors rather than from mechanical strain.

| S-EPMC7174329 | biostudies-literature

Peripheral lamina cribrosa depth in primary open-angle glaucoma: a swept-source optical coherence tomography study of lamina cribrosa.

Project description:PurposeTo investigate peripheral lamina cribrosa depth (PLCD) and its vertical-horizontal difference in eyes with primary open-angle glaucoma (POAG).MethodsPatients with POAG (n=90 eyes) and age-matched healthy individuals (n=90 eyes) underwent swept-source optical coherence tomography (SS-OCT) scans centered at the optic discs. The PLCD was defined as the vertical distance between the most peripheral visible end of anterior lamina cribrosa (LC) surface and the reference plane connecting the Bruch's membrane openings. The PLCD in each quadrant region and the vertical-horizontal PLCD difference were compared between the POAG and healthy eyes. The clinical factors associated with increased PLCD were evaluated.ResultsThe PLCD was significantly larger in the POAG eyes than the control eyes at the horizontal (P=0.034) and vertical (P=0.001) meridians. The vertical PLCD was significantly larger than the horizontal PLCD, both in the POAG eyes (P<0.001) and in the control eyes (P=0.003). However, the vertical-horizontal PLCD difference was significantly larger in the POAG eyes (47±60??m) than in the control eyes (18±54??m, P=0.001). Multivariate regression showed a significant association of male gender (P=0.005), increased baseline IOP (P=0.043), and decreased MD of VF (P=0.025) with increased PLCD.ConclusionsThe peripheral LC was displaced more posteriorly in the POAG eyes compared with the age-matched healthy eyes. In the POAG eyes, the peripheral LC was displaced more posteriorly at the vertical meridian than at the horizontal meridian. The peripheral LC in the vertical meridian might have increased IOP-related strain (deformation) compared with horizontal meridian in glaucomatous eyes.

| S-EPMC4815695 | biostudies-literature

Lamina Cribrosa Curvature in Healthy Korean Eyes.

Project description:Given that posterior bowing of the lamina cribrosa (LC) is a principle event in the development of glaucomatous damage, assessment of the LC morphology may have clinical utility in diagnosing and managing glaucoma patients. LC curvature has been suggested as an index to evaluate the LC morphology. To apply LC morphology in clinical practice, it is necessary to know normal profiles of LC curvature in healthy population. This study was performed to investigate the characteristics of LC curvature in healthy eyes using enhanced depth imaging spectral-domain optical coherence tomography in a total of 250 eyes of 125 healthy Korean subjects. The lamina cribrosa curvature index (LCCI) values at seven locations spaced equidistantly across the vertical optic disc diameter were measured on serial horizontal B-scan images. The mean value of the seven measurements was defined as the average LCCI. The average LCCI was 7.46 ± 1.22 (range, 4.29-10.48) and did not differ significantly between the right and left eyes. There was a strong inter-eye correlation within subjects. LCCI was significantly larger in eyes with shorter axial length (P < 0.001). The observed range of LCCI in healthy subjects may be used as a reference for evaluating LC curvature in glaucomatous eyes.

| S-EPMC6370828 | biostudies-literature

Assessment of sympathetic index from the Valsalva maneuver.

Project description:ObjectiveBlood pressure (BP) decline and recovery during the Valsalva maneuver (VM) are used to evaluate the degree of sympathetic failure (SF) but a reliable sympathetic index (SI) derived from VM is lacking.MethodsPatients with mild (n=20), moderate (n=65), and severe (n=60) SF and 23 healthy controls were evaluated using a standardized battery of autonomic tests. SF was defined as mild (associated with reduced sudomotor volumes at distal leg); moderate (associated with a fall in systolic BP ?10< 30 mm Hg during the tilt test); and severe (associated with a fall in systolic BP ?30 mm Hg during the tilt test). Six SIs were compared: SI1 (BP fall during phase 2), SI2 (BP recovery during phase 2), SI3 (the difference in BP between baseline and the end of phase 2), SI4 (the magnitude of phase 4), SI5 (BP recovery time), and SI6 (baroreflex sensitivity index).ResultsAll indexes showed overall significant differences among tested groups (p<0.05). Only SI3 differentiated all subject groups. Compared to other SIs, SI3 correlated the most with orthostatic hypotension (OH; r=0.62, p < 0.05) during the tilt.ConclusionsSI3 is the optimal method for calculation of SI since it 1) easily differentiates between healthy controls and those with SF; 2) correlates with the OH, a proxy for a sympathetic failure; 3) tracks the full spectrum of SF (mild-moderate-severe). SI3 expands the utility of quantitative autonomic testing.

| S-EPMC3269073 | biostudies-literature

Nasal displacement of retinal vessels on the optic disc in glaucoma associated with a nasally angled passage through lamina cribrosa.

Project description:To investigate nasal displacement of central retinal vessel (CRV) on the optic nerve head (ONH) in glaucoma in association with its passage through lamina cribrosa (LC). This cross-sectional study included 113 eyes with glaucoma and 60 normal eyes. Horizontal spectral-domain optical coherence tomography (SD-OCT) scans of the ONH were acquired, and point where CRV emerged on the ONH surface was defined as the position of the CRV. Next, radial scans of the ONH were acquired, and angle of the CRV passing through the LC was measured. These parameters were compared between glaucomatous and normal eyes by t-test, and their relationship with possible confounders was assessed by multiple regression analyses. In glaucoma, CRV was significantly more nasally displaced than it was in normal eyes (66.0 ± 8.6 vs. 54.3 ± 9.5, P < 0.0001), and eyes with more vessel displacement exhibited significantly worse glaucomatous visual field defects (P = 0.0004). Greater nasal displacement of the CRV was significantly associated with a more nasally angled path through the LC (rs = 0.569, P < 0.0001). By using SD-OCT, we confirmed that nasal displacement of the CRV on the ONH was associated with glaucoma and was induced by its nasally angled path through the LC.

| S-EPMC7892818 | biostudies-literature

Cauda equina movement during the Valsalva maneuver in two patients with Lumbar spinal canal stenosis.

Project description:Lumbar spinal canal stenosis (LSS) is a common spinal disorder among older people. Some LSS patients say that their pain worsens when they lift heavy objects. The Valsalva maneuver is the optimal breathing pattern for producing maximal force. Herein, we present two cases of LSS where the movement of the cauda equina was observed during the Valsalva maneuver.Case Summary:Case 1: A 74-year-old female with a history of LSS presented to our Department of Urology with frequent urination. The patient was diagnosed as having uterine and bladder prolapse. Pelvic cine MRI scan was conducted for detailed evaluation. While the Valsalva maneuver was performed to diagnose pelvic organ prolapses, we observed movement of the cauda equina. Spine MRI and CT, performed one year before presentation, showed severe LSS due to degenerative spondylolisthesis.Case 2: A 73-year-old male underwent radical prostatectomy for prostate cancer. A follow-up cine MRI to confirm urethrorrhea showed the cauda equina moving during the Valsalva maneuver. Moderate LSS due to degenerative spondylolisthesis was retrospectively found on abdominal CT performed before prostatectomy.Conclusion: The findings of our report suggest that movement of the cauda equina during the Valsalva maneuver may be implicated in LSS.

| S-EPMC9493334 | biostudies-literature

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