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Autoregulation is defined as the ability of a vascular bed to adapt its vascular resistance to changes in perfusion pressure. In the eye, several studies have reported that retinal blood flow is autoregulated over a wide range of ocular perfusion pressures. Large scale studies have shown that reduced ocular perfusion pressure is an important risk factor for the prevalence, the incidence and the progression of primary open angle glaucoma.
Former studies that investigated ocular blood flow autoregulation focused mainly on choroidal blood flow. For the optic nerve head only few data are available, although it seems likely that it underlies similar autoregulatory mechanisms.
A previous study investigating choroidal blood flow has shown that nitric oxide (NO) plays a key role in choroidal autoregulation. The present study is designed to test the hypothesis that NO plays a role in optic nerve head autoregulation during increased intraocular pressure (IOP). Therefore, IOP will be experimentally increased using a suction cup device in the absence of presence of either a nitric oxide synthase inhibitor (L-NMMA), an α-receptor agonist (phenylephrine) or placebo. Optic nerve head blood flow will be continuously measured during the procedure.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| NG-monomethyl-L-arginine (L-NMMA) | Active Comparator |
| |
| Phenylephrine | Active Comparator |
| |
| Physiological saline solution | Placebo Comparator |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| NG-monomethyl-L-arginine (L-NMMA) | Drug | bolus 6mg/kg over 5 minutes followed by a continuous infusion of 60µg/kg/min over 15 minutes |
|
| Measure | Description | Time Frame |
|---|---|---|
| optic nerve head pressure-flow relationship | 1 year |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Gabriele Fuchsjaeger-Mayrl, MD, Univ.Doz. | Department of Clinical Pharmacology, Medical University of Vienna | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Department of Clinical Pharmacology, Medical University of Vienna | Vienna | State of Vienna | 1090 | Austria |
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| Phenylephrine | Drug | 1µg/kg/min, infusion period 20 minutes |
|
| Physiological saline solution (as placebo) | Drug | infusion period 20 minutes |
|
| Laser Doppler Flowmetry | Device | Measurements will be performed at the neuroretinal rim to assess ONH blood flow. |
|
| Goldmann applanation tonometer | Device | intraocular pressure measurements |
|
| Suction cup | Device | Experimental stepwise increase of intraocular pressure while measurement of optic nerve head blood flow. |
|
| ID | Term |
|---|---|
| D019323 | omega-N-Methylarginine |
| D010656 | Phenylephrine |
| D017078 | Laser-Doppler Flowmetry |
| ID | Term |
|---|---|
| D001120 | Arginine |
| D024361 | Amino Acids, Basic |
| D000596 | Amino Acids |
| D000602 | Amino Acids, Peptides, and Proteins |
| D000599 | Amino Acids, Diamino |
| D000601 | Amino Acids, Essential |
| D004983 | Ethanolamines |
| D000605 | Amino Alcohols |
| D000438 | Alcohols |
| D009930 | Organic Chemicals |
| D000588 | Amines |
| D003935 | Diagnostic Techniques, Cardiovascular |
| D019937 | Diagnostic Techniques and Procedures |
| D003933 | Diagnosis |
| D012212 | Rheology |
| D008919 | Investigative Techniques |
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