In reply
I thank Dr Jonas for his comments on our article.
It is difficult for us to estimate whether increased cerebrospinal fluid pressure in the supine position is "good" or "bad." I agree that it might be good based on the point that the cerebrospinal fluid pressure acts as counterpressure to the IOP. As Dr Jonas and colleagues1-2 have described, an increase in the transmural pressure leads to glaucomatous damage, and the lamina cribrosa is thinner in eyes with glaucoma.
However, increased cerebrospinal fluid pressure while the patient is supine may be bad based on the fact that the IOP and cerebrospinal fluid pressure press on the lamina cribrosa from both sides. This dual pressure leads to decreased blood perfusion in the lamina cribrosa, making it atrophic.
In our study, I am convinced that the average IOP and the peak IOP are more important than the . . . [Full Text of this Article]
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