Publication: Rentabilidad diagnóstica del ánalisis colorimétrico papila y correlación con tomografía de coherencia óptica del dominio espectral y tomografía láser confocal en glaucoma e hipertensión ocular
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2017-02-24
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Universidad Complutense de Madrid
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Abstract
El glaucoma es una enfermedad multifactorial que constituye una de las principales causas de ceguera en países industrializados y cuya fisiopatología aún no se conoce completamente. Se sabe que el glaucoma engloba un grupo de neuropatías ópticas de origen multigénico y multifactorial, caracterizadas por una degeneración progresiva del nervio óptico, la muerte de las células ganglionares de la retina y la pérdida de campo visual. Sin embargo, a pesar del gran número de publicaciones científicas e investigaciones llevadas a cabo en las últimas décadas, su patogénesis no ha sido descrita de forma precisa y detallada. Dentro de los glaucomas, la forma más frecuente es el glaucoma primario de ángulo abierto (GPAA), cuyo principal factor de riesgo es la presión intraocular (PIO). La PIO desempeña un papel relevante en el establecimiento y progresión de la enfermedad y representa el único parámetro sobre el que es posible actuar a través de los diversos tratamientos disponibles en la actualidad. Sin embargo, la disregulación del flujo sanguíneo ocular con la consiguiente hipoxia tisular, secundaria a la elevación de la PIO o independientemente de ella, se ha implicado recientemente como un componente del mecanismo patogénico de la degeneración del nervio óptico y de la pérdida de células ganglionares retinianas en el glaucoma. El flujo ocular está disminuido en los glaucomas normotensivos y en aquellos GPAA que progresan a pesar de la reducción de PIO. Además, existe correlación entre la progresión campimétrica y las variables hemodinámicas retrobulbares. Muchos pacientes con glaucoma muestran alteraciones vasculares tales como vasoespasmo, hipotensión sistémica, defectos angiográficos de perfusión vascular y alteraciones en los parámetros de flujo sanguíneo que pueden conllevar una reducción de la perfusión vascular de la papila del nervio óptico y la retina...
Glaucoma is a multifactorial disease and its precise pathogenesis, despite extensive research, remains unknown. Glaucoma refers to a group of diseases that have a characteristic optic neuropathy in common. Glaucoma is an important cause of blindness and the ganglion cell death seen in glaucomatous optic neuropathy may be mediated by many factors. Intraocular pressure (IOP) is considered the main risk factor for the development and progression of glaucoma and it is the only treatable risk factor. However, alterations in ocular blood flow have become increasingly implicated in primary open angle glaucoma (POAG) disease pathology. Dysregulation of blood flow with subsequent tissue hypoxia has been implicated as a component of the pathogenic mechanisms of optic nerve degeneration and retinal ganglion cell loss in glaucoma. Many patients with glaucoma also show vascular alterations such as vasospasm, systemic hypotension, angiographic vascular perfusion defects and modified blood flow variables, which could lead to a diminished blood supply to the optic nerve head (ONH) and retina. Tissue perfusion clearly depends on blood volume to the same extent or even more than its degree of oxygenation, whose reduction in glaucoma is moderate. Therefore, adequate assessment of perfusion of the ONH could facilitate the early detection of the establishment of glaucoma, a disease where early diagnosis is crucial to establish an effective treatment. Regarding the techniques used to measure ocular blood flow (color Doppler imaging, confocal scanning laser ophthalmoscopic, angiography with fluorescein and indocyanine green dye, laser blood flowmetry, scanning laser Doppler flowmetry, and retinal photographic oximetry), most of them are not used in day-to-day clinical practice. To our knowledge, the measurement of blood volume in ONH tissue has only been attempted by a few investigators using spectrophotometric analysis of the ONH, reflectometry, etc...
Glaucoma is a multifactorial disease and its precise pathogenesis, despite extensive research, remains unknown. Glaucoma refers to a group of diseases that have a characteristic optic neuropathy in common. Glaucoma is an important cause of blindness and the ganglion cell death seen in glaucomatous optic neuropathy may be mediated by many factors. Intraocular pressure (IOP) is considered the main risk factor for the development and progression of glaucoma and it is the only treatable risk factor. However, alterations in ocular blood flow have become increasingly implicated in primary open angle glaucoma (POAG) disease pathology. Dysregulation of blood flow with subsequent tissue hypoxia has been implicated as a component of the pathogenic mechanisms of optic nerve degeneration and retinal ganglion cell loss in glaucoma. Many patients with glaucoma also show vascular alterations such as vasospasm, systemic hypotension, angiographic vascular perfusion defects and modified blood flow variables, which could lead to a diminished blood supply to the optic nerve head (ONH) and retina. Tissue perfusion clearly depends on blood volume to the same extent or even more than its degree of oxygenation, whose reduction in glaucoma is moderate. Therefore, adequate assessment of perfusion of the ONH could facilitate the early detection of the establishment of glaucoma, a disease where early diagnosis is crucial to establish an effective treatment. Regarding the techniques used to measure ocular blood flow (color Doppler imaging, confocal scanning laser ophthalmoscopic, angiography with fluorescein and indocyanine green dye, laser blood flowmetry, scanning laser Doppler flowmetry, and retinal photographic oximetry), most of them are not used in day-to-day clinical practice. To our knowledge, the measurement of blood volume in ONH tissue has only been attempted by a few investigators using spectrophotometric analysis of the ONH, reflectometry, etc...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Oftalmología y Otorrinolaringología, leída el 04-02-2016