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Role of Translaminar Pressure Gradient Differences in Glaucoma - A Review

Review article



Glaucoma is a group of diseases which result in a progressive loss of retinal ganglion cells, producing characteristic optic nerve head appearance with  corresponding visual loss. The aetiology remains unclear until today. Previous authors had tried to associate its pathology in relation to intracranial pressure level. We review the literature on interrelation of intraocular pressure (IOP) and intracranial pressure (ICP) which gives rise to the study of translaminar pressure gradient (TLPG) in postulating its causal factor towards glaucoma. Several studies had demonstrated that ICP was reduced in patients with glaucoma, and in sequence with normal or raised IOP, leads to increased level of TLPG. The  increased TLPG which acts across the lamina cribrosa may cause a posteriorly bowed lamina cribrosa, therefore leading to glaucomatous changes. This review also explores the current available methods in measuring ICP accurately. Further studies are needed to elucidate possible disease mechanism in keeping with IOP-ICP relationship, thus confirming the findings of previous authors.