ULTRASONIC FEATURES OF THE OCULAR BLOOD FLOW IMPAIRMENT AND THE CHANGES OF CAROTID ARTERIES IN PATIENTS WITH PRIMARY OPEN-ANGLE GLAUCOMA

Rationale. It is proved that the changes of ocular blood flow play an important role in the mechanism of primary open-angle glaucoma (POAG) development. The impact of occlusive-stenotic lesions of carotid arteries on POAG progression has been discussed in the course of the last ten years.Objective: to study the characteristics of ocular blood flow and the changes of carotid arteries in patients with various stages of POAG.Methods: 125 patients (210 eyes) with various stages of POAG, 65 eyes of them with early stage of POAG (1st group), 126 eyes with moderate stage (2nd group) and 19 eyes with advanced stage (3rd group) were examined. 20 healthy individuals (40 eyes) without ocular pathology and cardiovascular diseases constituted the control group. Ultrasound examination including Color Doppler imaging and pulse dopplerography were used for investigation of blood flow in ocular vessels in the retrobulbar region. The peak systolic velocity (PSV), end diastolic velocity (EDV) and resistance index (RI) were measured in the ophthalmic artery (OA), central retinal artery (CRA) and paraneural medial and lateral short posterior ciliary arteries (sPSA). According to the NASCET criteria, carotid stenosis is categorized.Results: There was a statistically significant decrease of PSV, EDV in OA and the increase of RI in OA in eyes with advanced stage of POAG compared to control group and the 1st group (р< 0,05). The results showed significant decrease of EDV and the increase of RI in CRA, medial and lateral sPSA compared to control and the 1st group that might indicate reduced retinal and choroidal blood flow. Ultrasound examination of carotid arteries showed critical stenosis of internal carotid artery (ICA) on ipsilateral side in 7,9% and 31,5% of cases in the 2nd and the 3rd groups, respectively. The mild stenosis of ICA was detected in the most cases (90,8%) of early POAG.Conclusion: Ultrasound examination with the assessment of blood flow is noninvasive, available and high-informative method for the diagnostics of pathological changes of blood flow in ocular vessels in patients with POAG.Early detection of impaired local blood flow and the pathology of carotid arteries in patients with glaucoma might contribute to determine the patient care management.