Влияние нарушения венозного оттока в синусах головного мозга на прогрессирование глаукомного процесса

Abstract

Purpose. To evaluate the effect of impaired venous return in the brain sinuses on the progression of glaucoma. Material and methods. We examined 15 people (6 men and 9 women aged 55–85 years) with primary open-angle glaucoma (POAG) of stages I–III and normalized intraocular pressure (IOP) but with the progression of glaucoma optic neuropathy (GON). In addition to the generally accepted ophthalmological methods of examination, optical coherence tomography (OCT) and magnetic resonance imaging (MRI) of the brain with sinusovenography and neurologist consultation were used. Results. The patients had a magnetic resonance pattern of asymmetry of blood flow along the sinuses of the dura mater with a decreased blood flow along the left or right transverse, sigmoid sinuses (signs of sinus hypoplasia), as well as along the left or right internal jugular vein. Magnetic resonance signs of moderate external communicating hydrocephalus were noted in 1 patient. Another patient had magnetic resonance signs of moderate cerebrospinal hypertension in the ventricles and suprasellar cistern. It should be noted that the side of the impaired venous return in the brain sinuses corresponded to the eyes with the progression of GON. The patients underwent complex treatment, including a long course of venotonics to improve venous return, taking into account the recommendations of a neurologist. Conclusion. Impaired venous return in the brain sinuses certainly has a significant negative effect on the progression of GON in patients with POAG and normalized ophthalmotonus. In this regard with the progression of glaucoma, patients with normalized ophthalmotonus are recommended to have an MRI of the brain with sinusovenography. If there is a violation of venous return through the sinuses of the dura mater, which corresponds to the eyes with the progression of GON, a neurologist’s consultation and complex therapy, including a long course of venotonics are indicated. Keywords: primary open-angle glaucoma, normalized intraocular pressure, progression of glaucoma optic neuropathy, impaired venous return in the brain sinuses, complex treatment, venotonics