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Ocular Pulse Amplitude and Retrobulbar Blood Flow Change in Dipper and Nondipper Individuals

Ocular Pulse Amplitude and Retrobulbar Blood Flow Change in Dipper and Nondipper Individuals. Ibrahim F. Hepsen hepsenif@hotmail.com Remzi Karadag drrkaradag@yahoo.com Ugur Can Keskin ugurcankeskin@hotmail.com Asli Koktener akoktener@yahoo.com Yusuf Selcoki yussel@hotmail.com

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Ocular Pulse Amplitude and Retrobulbar Blood Flow Change in Dipper and Nondipper Individuals

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  1. Ocular Pulse Amplitude and Retrobulbar Blood Flow Change in Dipper and Nondipper Individuals Ibrahim F. Hepsen hepsenif@hotmail.com Remzi Karadag drrkaradag@yahoo.com Ugur Can Keskin ugurcankeskin@hotmail.com Asli Koktener akoktener@yahoo.com Yusuf Selcoki yussel@hotmail.com Mehmet Kanbay drkanbay@yahoo.com Fatih University Medical School, Ankara, Turkey Authors have no financial interests.

  2. Introduction Blood pressure measurements without a fall in nocturnal blood pressure are called as nondipping, and with a fall in nocturnal blood pressure is called as dipping.Hemodynamic changes like nocturnal hypotension were suggested to have a role in pathogenesis of glaucomatous optic nerve damage and anterior ischemic optic neuropathy.It has been shown that nocturnal blood pressure decrease is much more in glaucoma patients than normal patients. Several color Doppler imaging studies have shown retrobulbar blood flow velocity reduction and resistivity index elevation in glaucoma patients.Ocular pulse amplitude (OPA) obtained by dynamic contour tonometer (DCT) is thought to be an indirect indicator of the choroidal perfusion and reflects the ocular blood flow corresponding to the heart pulse as a function of time. Relationship between OPA and hemodynamic changes was also investigated in some studies.

  3. Purpose To the best of our knowledge, therelationship between OPA and dipper and non dipper patients has not been studied. We therefore designed this study to evaluate OPA, IOP values and hemodynamic changes in the ophthalmic artery, central retinal artery and short posterior ciliary artery in dipper and nondipper patients.

  4. Methods Fiftynine right eye measurements of healthy subjects with controlled systemic blood pressure were included to the study. Ambulatory blood pressure (BP) monitoring measurement (ABPM), Doppler imaging and OPA measurements were performed in the same day. The patients in which systolic BP decreased during the nocturnal time by 10% of the diurnal BP or more were called as dippers. A patient whose nocturnal systolic BP fell by <10% or even rose was defined as nondipper. Color Doppler imaging was used for blood flow velocity assessment of ophthalmic, central retinal and posterior ciliary arteries. For each artery, peak systolic and end-diastolic velocities (PSV and EDV, respectively), resistive index (RI) and pulsalite index (PI) were automatically calculated by the machine. Mean IOP and OPA values were calculated after three consecutive measurements.

  5. Results There was no significant difference in the mean age (P = .976), mean blood pressure (P = .149) for systolic blood pressure and (P = .303) for diastolic blood pressure), and IOP (P = .692) between the groups. In addition, the mean OPA in Non-dipper patients was significantly lower compared with that of dipper patients (P = .011). Figure-1 shows the distribution of OPA levels in both groups. The retrobulbar blood flow velocities and resistivity indices of the subjects are represented in Table 1-3. There was no significant difference in the PSV, EDV, RI and PI in the ophthalmic (P = .482, P = .453, P = .180, P = .146 respectively) central retinal (P = .288, P = .347, P = .462, P = .288 respectively) and posterior ciliary (P = .491, P = .081, P = .360, P = .235 respectively) arteries between the groups.

  6. The distribution of OPA levels in both groups

  7. Hemodynamic values (mean ± SD) measured in the central retinal arteryfor the study groups PSV; Peak systolic velocity, EDV; End-diastolic velocity, RI; Resistivity index; PI; Pulsatilite index

  8. Hemodynamic values (mean ± SD) measured in the ophthalmic arteryfor the study groups PSV; Peak systolic velocity, EDV; End-diastolic velocity, RI; Resistivity index; PI; Pulsatilite index

  9. Hemodynamic values (mean ± SD) measured in the posterior ciliary artery for the study groups PSV; Peak systolic velocity, EDV; End-diastolic velocity, RI; Resistivity index; PI; Pulsatilite index

  10. Conclusion Our study demonstrated that OPA levels in nondippers are lower than dippers and this may give additional information about the effect of blood pressure changes on OPA values. We found no difference in ocular blood flow parameters between nondipper and dipper patients. The possible etiologic reasons of BP decline during nighttime, as described before may be the cause of difference in OPA levels in nondippers. Further studies are needed for finding the OPA changes in dipper/nondippers especially in glaucoma patients and affect of these changes on glaucomatous optic nerve damage.

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