Abstract
To investigate the effects of the Valsalva maneuver (VM) on optic disc morphology, choroidal thickness, and anterior chamber parameters. This prospective observational study included 60 eyes of 60 healthy subjects. The anterior chamber parameters, including central corneal thickness (CCT), anterior chamber depth (ACD), anterior chamber angle (ACA), anterior chamber volume (ACV), pupil diameter (PD), axial length (AL), subfoveal and peripapillary choroidal thickness, optic disc parameters, and intraocular pressure (IOP), were measured at rest and during VM. VM did not have any significant influence on AL, subfoveal and peripapillary choroidal thickness, optic disc area, rim area, cup area, cup-to-disc area ratio, vertical cup-to-disc ratio, rim volume, cup volume, and nerve head volume measurements (for all; p >0.05). IOP and PD significantly increased during VM (for both; p <0.001). VM significantly decreased CCT, ACD, ACA, and ACV values (for all; p <0.001). Moreover, the optic nerve cup volume decreased and the horizontal cup-to-disc ratio significantly increased during VM (for both; p <0.05). VM may cause transient changes in IOP, optic disc morphology, and anterior chamber parameters.
Highlights
The Valsalva maneuver (VM) is performed frequently in daily acti vities
The effects of VM on intraocular pressure (IOP), axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), anterior chamber angle (ACA), anterior chamber volume (ACV), and pupil diameter (PD) are shown in table 1
The IOP rise during VM has been correlated with both the amount of expiratory force produced and the length of time taken in the maneuver[11]
Summary
The Valsalva maneuver (VM) is performed frequently in daily acti vities It causes various transient physiological changes, including elevated blood pressure, increased intrathoracic pressure, increased peripheral venous pressure stimulation of the peripheral sympathetic system, and increased intraocular pressure (IOP)(1,2). One hypothesis is that the increased systemic venous pressure is transmitted through the jugular, orbital, and vortex veins to the choroid, causing vascular engorgement and increases in choroidal volume and IOP. Researchers have showed that VM causes significant changes in anterior chamber parameters and an increase in uveal thickness that leads to a transient increase in IOP in healthy subjects[3,4]. These dynamic changes may induce acute angle-closure glaucoma (AACG)(7,8). Normotensive glaucoma (NTG) has been reported to be more common in patients with exposure to increases in IOP caused by intrathoracic and intra-abdominal pressure, such as that from playing wind instruments, lifting weights regularly, asthma, or having chronic urinary tract or intestinal obstruction[9]
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