Detection of disturbed autoregulation of the peripapillary choroid in primary open angle glaucoma.

BACKGROUND AND OBJECTIVE: This study is concerned with perfusion-pressure videoangiographic investigations, performed by combining oculo-oscillo-dynamography and videoangiography. Perfusion-pressure videoangiography permits an evaluation of local vascular resistance in the choroid relative to ciliary perfusion pressure. PATIENTS AND METHODS: Twelve healthy subjects, 21 patients with primary open angle glaucoma (POAG), and 27 patients with ocular hypertension were examined. RESULTS: Perfusion-pressure videoangiograms revealed that the peripapillary choroid (nasal main ciliary artery) filled at distinctly lower perfusion pressures than the paramacular region (temporal main ciliary artery) in all 12 healthy subjects, with a perfusion pressure difference of 12.5 +/- 4.9 mm Hg. In the 21 patients with POAG, the perfusion pressure difference between the beginning of peripapillary and paramacular perfusion was as small as 3.7 +/- 4.5 mm Hg. In the 27 patients with ocular hypertension, the perfusion pressure difference between the two circulatory regions was almost as high as in the healthy subjects. CONCLUSIONS: These examinations showed that (1) there exists efficient autoregulation in the peripapillary choroids of healthy subjects, (2) autoregulation is diminished or even absent in POAG, and (3) autoregulation is normal, increased, or slightly reduced in ocular hypertension.