Glaucomatous optic nerve head alterations in patients with chronic heart failure
Daniel Meira-Freitas1, Luiz Alberto S Melo Jr1, Daniela B Almeida-Freitas2, Augusto Paranhos Jr1
1Department of Ophthalmology, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil; 2Imaging Diagnosis Department, Universidade Federal de São Paulo – UNIFESP, São Paulo, Brazil
Purpose: To evaluate the association between chronic heart failure (CHF) and optic nerve head alterations.
Methods: A cross-sectional study was performed. Heart failure patients with recent echocardiograms were subjected to ophthalmologic examinations, including intraocular pressure measurement, optic nerve head, and retinal nerve fiber layer evaluation using stereophotography, Heidelberg retinal tomography, and standard automated perimetry. The ocular findings were correlated with the cardiological evaluation, and compared with a control group without cardiopathy.
Results: A total of 30 patients with CHF and 30 individuals without cardiopathy were enrolled in this study. The mean (standard deviation [SD]) intraocular pressure was 12.3 (2.5) mmHg in the CHF group, and 14.7 (2.9) mmHg in the control group (P < 0.001). The mean (SD) arterial blood pressure was 86.9 (17.1) mmHg in the CHF group, and 103.6 (15.2) mmHg in the control group (P < 0.001). The mean (SD) ocular perfusion pressure was 45.6 (11.1) mmHg in the CHF group, and 54.4 (10.4) mmHg in the control group (P = 0.001). The mean (SD) rim area was 1.41 (0.3) mm2 in the CHF group, and 1.60 (0.26) mm2 in the control group (P = 0.003). The mean (SD) vertical cup/disc ratio was 0.51 (0.17) in the CHF group, and 0.41 (0.18) in the control group (P = 0.02). The Moorfields regression analysis was outside the normal limits in 16 out of 58 (27.6%) eyes of the CHF subjects, and in 4 out of 60 (6.7%) eyes of the control subjects (P = 0.01). The frequency of glaucoma was 10% in the CHF group, whereas none of the control subjects met the criteria for the diagnosis of glaucoma (P = 0.24).
Conclusion: CHF is associated with lower ocular perfusion pressure, and glaucomatous optic nerve head changes.
Keywords: chronic heart failure, optic disk, glaucoma, intraocular pressure
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