Systemic hypotension and low perfusion pressure as risk factors for primary open-angle glaucoma progression

Abstract

O.S. Мyakonkaya1, A.S. Sarkisyan1, A.V. Seleznev2, A.V. Kuroyedov3,4, A.Yu. Brezhnev5 1Volgograd Branch of the S. Fyodorov Eye Microsurgery Federal State Institution, Volgograd, Russian Federation 2Ivanovo State Medical Academy, Ivanovo, Russian Federation 3Mandryka Central Military Clinical Hospital, Moscow, Russian Federation 4Pirogov Russian National Research Medical University, Moscow, Russian Federation 5Kursk State Medical University, Kursk, Russian Federation Glaucoma progression is still a relevant issue in up-to-date ophthalmology. An important prerequisite for stabilizing glaucoma is the achievement of the target intraocular pressure (IOP). However, many patients with primary open-angle glaucoma (POAG) continue to suffer vision loss despite IOP reduction. Additional factors are also important for glaucoma progression, e.g., blood pressure (BP) and ocular perfusion pressure (OPP). Multiple published data have shown a decrease in blood flow velocity in the retrobulbar vessels, choroid, retina, and optic nerve in patients with glaucoma. A decrease in OPP is a predictor of insufficient intraocular blood supply. Systemic BP has a strong effect on OPP. Intensive treatment for hypertension significantly reduces BP, decreases OPP, and prevents the progression of glaucomatous optic neuropathy. A new paradigm shift that implies a personalized approach to the choice of diagnostic and treatment strategy for glaucoma is emerging. This paper reviews current published data on the effect of systemic hypotension and low OPP on POAG progression. Keywords: glaucoma, intraocular pressure, blood pressure, hypertension, hypotension, perfusion pressure. For citation: Мyakonkaya O.S., Sarkisyan A.S., Seleznev A.V., Kuroyedov A.V., Brezhnev A.Yu. Systemic hypotension and low perfusion pressure as risk factors for primary open-angle glaucoma progression. Russian Journal of Clinical Ophthalmology. 2023;23(4):202–206 (in Russ.). DOI: 10.32364/2311-7729-2023-23-4-5.