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January 1983, Vol 101, No. 1 >
ARTICLE | January 1983

Blockage of Axonal Transport in Optic Nerve Induced by Elevation of Intraocular Pressure: Title and subTitle BreakEffect of Arterial Hypertension Induced by Angiotensin I FREE

Douglas R. Anderson, MD; Nunzio Sossi, PhD
[+] Author Affiliations

Accepted for publication Dec 7, 1981.

Read in part at the annual spring meeting of the Association for Research in Vision and Ophthalmology, Sarasota, Fla, April 28, 1981.

Reprint requests to Bascom Palmer Eye Institute, PO Box 016880, Miami, FL 33101 (Dr Sossi).

This study was supported in part by Public Health Service research grant EY-00031 from the National Eye Institute, by a William and Mary Greve International Eye Research Scholarship awarded by Research to Prevent Blindness, Ine (Dr Anderson), and by the Glaucoma Research Fund of the National Health Assistance Foundation, Washington, DC.

E. Barry Davis provided technical assistance.


Arch Ophthalmol. 1983;101(1):94-97. doi:10.1001/archopht.1983.01040010096017
Text Size: A A A
Published online
Article
References
Comments

• Previous studies have shown that elevation of intraocular pressure blocks rapid axonal transport at the lamina cribrosa of the optic nerve. In this study, IOP-induced blockage of axonal transport was greater in cats with elevation of BP induced by angiotensin I than in control animals with normal BP. The fact that cardiovascular factors influenced IOPinduced blockage of axonal transport suggests that it is due to ischemia; if the blockage were a direct mechanical effect of the IOP on the axons, it should be unaffected by BP. The data also suggest that the vasoconstrictive properties of angiotensin I reduced the ability of the vasculature of the optic nerve head to autoregulate when challenged by elevation of IOP.

REFERENCES

1 +
Anderson DR, Hendrickson A:  Effect of intraocular pressure on rapid axoplasmic transport in monkey optic nerve . Invest Ophthalmol 1974;;13:771-783.
2 +
Minckler DS, Bunt AH, Johanson GW:  Orthograde and retrograde axoplasmic transport during acute ocular hypertension in the monkey . Invest Ophthalmol Vis Sci 1977;;16:426-441.
3 +
Minckler DS, Bunt AH, Klock IB:  Radioautographic and cytochemical ultrastructural studies of axoplasmic transport in the monkey optic nerve head . Invest Ophthalmol Vis Sci 1978;;17:33-50.
4 +
Minckler DS, Tso MOM, Zimmerman LE:  A light microscopic, autoradiographic study of axoplasmic transport in the optic nerve head during ocular hypotony, increased intraocular pressure, and papilledema . Am J Ophthalmol 1976;;82:741-757.
5 +
Gaasterland D, Tanishima T, Kuwabara T:  Axoplasmic flow during chronic experimental glaucoma: I. Light and electron microscopic studies of the monkey optic nervehead during development of glaucomatous cupping . Invest Ophthalmol Vis Sci 1978;;17:838-846.
6 +
Anderson DR, Hendrickson AE:  Failure of increased intracranial pressure to affect rapid axonal transport at the optic nerve head . Invest Ophthalmol Vis Sci 1977;;16:423-426.
7 +
Quigley HA, Addicks EM:  Chronic experimental glaucoma in primates: II. The effect of extended intraocular pressure elevation on optic nerve head and axonal transport . Invest Ophthalmol Vis Sci 1980;;19:137-152.
8 +
Quigley HA, Anderson DR:  The dynamics and location of axonal transport blockade by acute intraocular pressure elevation in primate optic nerve . Invest Ophthalmol Vis Sci 1976;;15:606-616.
9 +
Quigley HA, Guy J, Anderson DR:  Blockage of rapid axonal transport: Effect of intraocular pressure in primate optic nerve . Arch Ophthalmol 1979;;97:525-531.
10 +
Radius RL, Anderson DR:  Rapid axonal transport in primate optic nerve: Distribution of pressure-induced interruption . Arch Ophthalmol 1981;;99:650-654.
11 +
Radius RL, Anderson DR:  Breakdown of the normal optic nerve head and blood-brain barrier following acute elevation of intraocular pressure in experimental animals . Invest Ophthalmol Vis Sci 1980;;19:244-255.
12 +
Hayreh SS, March W, Anderson DR:  Pathogenesis of block of rapid orthograde axonal transport by elevated intraocular pressure , in Krieglstein GK, Leydhecker W (eds): Glaucoma Update: International Glaucoma Symposium, Nara, Japan, May 7-11, 1979 . New York, Springer-Verlag, 1979;, pp 119-125.
13 +
Quigley HA, Anderson DR:  Distribution of axonal transport blockade by acute intraocular pressure elevation in the primate optic nerve head . Invest Ophthalmol Vis Sci 1977;;16:640-644.
14 +
Radius RL, Schwartz EL, Anderson DR:  Failure of uinlateral carotid artery ligation to affect pressure-induced interruption of rapid axonal transport in primate optic nerves . Invest Ophthalmol Vis Sci 1980;;19:153-157.
15 +
Ochs S:  Local supply of energy to the fast axoplasmic transport mechanism . Proc Natl Acad Sci USA 1971;;68:1279-1282.
16 +
Lampert PW, Vogel MH, Zimmerman LE:  Pathology of the optic nerve in experimental acute glaucoma; electron microscopic studies . Invest Ophthalmol Vis Sci 1968;;7:199-213.
17 +
Barany E:  Experiments on axoplasmic flow , in Etienne R, Paterson GD (eds). International Glaucoma Symposium (Albi 1974) . Marseilles, France, Diffusion Generale de Librairie, 1975;, pp 83-84.
18 +
Barany E:  Ability of retrograde axoplasmatic flow to overcome pressure gradients: Preliminary communication . Doc Ophthalmol Proc Ser 1978;;16:215-219.
19 +
Emery JM, Landis D, Paton D, et al:  The lamina cribrosa in normal and glaucomatous human eyes . Trans Am Acad Ophthalmol Otolaryngol 1974;;78:290-297.
20 +
Maumenee AE:  The pathogenesis of visual field loss in glaucoma , in Brockhurst RJ, Boruchoff SA, Hutchinson BT, et al (eds): Controversy in Ophthalmology . Philadelphia, WB Saunders Co, 1977;, pp 301-311.
21 +
Maumanee AE:  Visual field loss in glaucoma , in Symposium on Glaucoma: Transactions of the New Orleans Academy of Ophthalmology. St Louis, CV Mosby Co, 1981;, pp 160-171.
22 +
Hahnenberger RW:  Effects of pressure on fast axoplasmic flow: An in vitro study in the vagus nerve of rabbits . Acta Physiol Scand 1978;;104:299-308.
23 +
Vrabec F:  Glaucomatous cupping of the human optic disc. A neuro-histologic study . Albrecht Von Graefes Arch Klin Exp Ophthalmol 1976;;198:223-234.
24 +
Anderson DR:  Axonal transport in the retina and optic nerve , in Glaser JS (ed): Neuro-Ophthalmology Symposium of the University of Miami and the Bascom Palmer Eye Institute . St Louis, CV Mosby Co, 1977;, vol 9, pp 140-153.
25 +
Anderson DR:  Papilledema and axonal transport , in Thompson HS, Daroff R, Frisen L, et al (eds): Topics in Neuro-Ophthalmology . Baltimore, Williams & Wilkins Co, 1979;, pp 184-189.
26 +
Radius RL, Anderson DR: The morphology of axonal transport abnormalities in primate eyes. Br J Ophthalmol, in press.
27 +
Radius RL:  Regional specificity in anatomy at the lamina cribrosa . Arch Ophthalmol 1981;;99:478-480.
28 +
Quigley HA, Addicks EM:  Regional differences in the structure of the lamina cribrosa and their relation to glaucomatous optic nerve damage . Arch Ophthalmol 1981;;99:137-143.
29 +
Quigley HA, Addicks EM, Green WR, et al:  Optic nerve damage in human glaucoma: II. The site of injury and susceptibility to damage . Arch Ophthalmol 1981;;99:635-649.
30 +
Geijer C, Bill A:  Effects of raised intraocular pressure on retinal, prelaminar, laminar, and retrolaminar optic nerve blood flow in monkeys . Invest Ophthalmol Vis Sci 1979;;18:1030-1042.
31 +
Sossi N, Anderson DR: Effect of elevated intraocular pressure on blood flow in cat optic nerve head studied with 125I-iodoantipyrine. Arch Ophthalmol, in press.
32 +
Wei EP, Kontos HA, Patterson JL Jr:  Vasoconstrictor effect of angiotensin on pial arteries . Stroke 1978;;9:487-489.
33 +
Edvinsson L, Hardebo JE, Owman CH:  Effects of angiotensin II on cerebral blood vessels . Acta Physiol Scand 1979;;105:381-383.
34 +
Severs WB, Daniels-Severs AE:  Effects of angiotensin on the central nervous system . Pharmacol Rev 1973;;25:415-449.
35 +
Ferrario CM, Gildenberg PL, McCubbin JW:  Cardiovascular effects of angiotensin mediated by the central nervous system . Circ Res 1972;;30:257-262.
36 +
Dollery CT, Hill DW, Hodge JV:  The response of normal retinal blood vessels to angiotensin and noradrenaline . J Physiol 1963;;165:500-507.
37 +
Anderson DR:  Ultrastructure of human and monkey lamina cribrosa and optic nerve head . Arch Ophthalmol 1969;;82:800-814.
38 +
Hayreh SS:  Blood supply of the optic nerve head and its role in optic atrophy, glaucoma, and oedema of the optic disc . Br J Ophthalmol 1969;;53:721.
39 +
Ernest JT, Potts AM:  Pathophysiology of the distal portion of the optic nerve: II. Vascular relationships . Am J Ophthalmol 1968;;66:380-387.
40 +
Francois J, Neetens A:  Vascularization of the optic pathway: I. Lamina cribrosa and optic nerve . Br J Ophthalmol 1954;;38:472-488.
41 +
Henkind P, Levitzky M:  Angioarchitecture of the optic nerve: I. The papilla . Am J Ophthalmol 1969;;68:979-986.
42 +
Levitzky M, Henkind P:  Angioarchitecture of the optic nerve: II. Lamina cribrosa . Am J Ophthalmol 1969;;68:986-996.
43 +
Lieberman MF, Maumenee AE, Green WR:  Histologic studies of the vasculature of the anterior optic nerve . Am J Ophthalmol 1976;;82:405-423.
44 +
Anderson DR:  Vascular supply to the optic nerve of primates . Am J Ophthalmol 1970;;70:341-351.
45 +
Anderson DR, Braverman S:  Reevaluation of the optic disk vasculature . Am J Ophthalmol 1976;;82:165-174.
46 +
Grayson MC, Laties AM:  Ocular localization of sodium fluorescein: Effects of administration in rabbit and monkey . Arch Ophthalmol 1971;;85:600-609.
47 +
Grayson MC, Tsukahara S, Laties AM:  Tissue localization in rabbit and moneky eye of intravenously-administered fluorescein , in Shimizu K (ed): Fluorescein Angiography: Proceedings of the International Symposium on Fluorescein Angiography, Tokyo, 1972 . Tokyo, Igaku Shoin Ltd, 1974;, pp 235-246.
48 +
Cohen AL:  Is there a potential defect in the blood-retinal barrier at the choroidal level of the optic nerve canal? Invest Ophthalmol Vis Sci 1973;;12:513-519.
49 +
Tso MOM, Shih C-Y, McLean IW:  Is there a blood-brain barrier at the optic nerve head? Arch Ophthalmol 1975;;93:815-825.
50 +
Okinami S, Ohkuma M, Tsukahara I:  Kuhnt intermediary tissue as a barrier between the optic nerve and retina . Albrecht Von Graefes Arch Klin Exp Ophthalmol 1976;;201:57-67.
51 +
Olsson Y, Kristensson K:  Permeability of blood vessels and connective tissue sheaths of retina and optic nerve . Acta Neuropathol 1973;;26:147-156.
52 +
Isukahara I, Yamashita H:  An EM study of blood-optic nerve and fluid-optic nerve barrier . Albrecht Von Graefes Arch Klin Exp Ophthalmol 1975;;96:239-246.
53 +
Ernest JT, Archer D:  Fluorescein angiography of the optic disc . Am J Ophthalmol 1973;;75:973-978.
54 +
Ben-Sira I, Riva CE:  Fluorescein diffusion in the human optic disc . Invest Ophthalmol Vis Sci 1975;;14:205-211.
55 +
Douglas GR, Drance SM, Schueltzer M:  The visual field and nerve head in angle-closure glaucoma: A comparison of the effects of acute and chronic angle closure . Arch Ophthalmol 1975;;93:409-411.
56 +
Radius RL, Maumenee AE:  Visual field changes following acute elevation of intraocular pressure . Trans Am Acad Ophthalmol Otolaryngol 1977;;83:61-68.
57 +
Brunner HR, Gavras H:  Is the renin system necessary? Am J Med 1980;;69:739-745.
58 +
Drance SM:  Some factors in the production of low tension glaucoma . Br J Ophthalmol 1972;;56:229-242.
59 +
Drance SM, Morgan RW, Sweeney VP:  Shock-induced optic neuropathy: A cause of non-progressive glaucoma . N Engl J Med 1973;;288:392-395.
60 +
Jampol LM, Board RJ, Maumenee AE:  Systemic hypotension and glaucomatous changes . Am J Ophthalmol 1978;;85:154-159.

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1 +
Anderson DR, Hendrickson A:  Effect of intraocular pressure on rapid axoplasmic transport in monkey optic nerve . Invest Ophthalmol 1974;;13:771-783.
2 +
Minckler DS, Bunt AH, Johanson GW:  Orthograde and retrograde axoplasmic transport during acute ocular hypertension in the monkey . Invest Ophthalmol Vis Sci 1977;;16:426-441.
3 +
Minckler DS, Bunt AH, Klock IB:  Radioautographic and cytochemical ultrastructural studies of axoplasmic transport in the monkey optic nerve head . Invest Ophthalmol Vis Sci 1978;;17:33-50.
4 +
Minckler DS, Tso MOM, Zimmerman LE:  A light microscopic, autoradiographic study of axoplasmic transport in the optic nerve head during ocular hypotony, increased intraocular pressure, and papilledema . Am J Ophthalmol 1976;;82:741-757.
5 +
Gaasterland D, Tanishima T, Kuwabara T:  Axoplasmic flow during chronic experimental glaucoma: I. Light and electron microscopic studies of the monkey optic nervehead during development of glaucomatous cupping . Invest Ophthalmol Vis Sci 1978;;17:838-846.
6 +
Anderson DR, Hendrickson AE:  Failure of increased intracranial pressure to affect rapid axonal transport at the optic nerve head . Invest Ophthalmol Vis Sci 1977;;16:423-426.
7 +
Quigley HA, Addicks EM:  Chronic experimental glaucoma in primates: II. The effect of extended intraocular pressure elevation on optic nerve head and axonal transport . Invest Ophthalmol Vis Sci 1980;;19:137-152.
8 +
Quigley HA, Anderson DR:  The dynamics and location of axonal transport blockade by acute intraocular pressure elevation in primate optic nerve . Invest Ophthalmol Vis Sci 1976;;15:606-616.
9 +
Quigley HA, Guy J, Anderson DR:  Blockage of rapid axonal transport: Effect of intraocular pressure in primate optic nerve . Arch Ophthalmol 1979;;97:525-531.
10 +
Radius RL, Anderson DR:  Rapid axonal transport in primate optic nerve: Distribution of pressure-induced interruption . Arch Ophthalmol 1981;;99:650-654.
11 +
Radius RL, Anderson DR:  Breakdown of the normal optic nerve head and blood-brain barrier following acute elevation of intraocular pressure in experimental animals . Invest Ophthalmol Vis Sci 1980;;19:244-255.
12 +
Hayreh SS, March W, Anderson DR:  Pathogenesis of block of rapid orthograde axonal transport by elevated intraocular pressure , in Krieglstein GK, Leydhecker W (eds): Glaucoma Update: International Glaucoma Symposium, Nara, Japan, May 7-11, 1979 . New York, Springer-Verlag, 1979;, pp 119-125.
13 +
Quigley HA, Anderson DR:  Distribution of axonal transport blockade by acute intraocular pressure elevation in the primate optic nerve head . Invest Ophthalmol Vis Sci 1977;;16:640-644.
14 +
Radius RL, Schwartz EL, Anderson DR:  Failure of uinlateral carotid artery ligation to affect pressure-induced interruption of rapid axonal transport in primate optic nerves . Invest Ophthalmol Vis Sci 1980;;19:153-157.
15 +
Ochs S:  Local supply of energy to the fast axoplasmic transport mechanism . Proc Natl Acad Sci USA 1971;;68:1279-1282.
16 +
Lampert PW, Vogel MH, Zimmerman LE:  Pathology of the optic nerve in experimental acute glaucoma; electron microscopic studies . Invest Ophthalmol Vis Sci 1968;;7:199-213.
17 +
Barany E:  Experiments on axoplasmic flow , in Etienne R, Paterson GD (eds). International Glaucoma Symposium (Albi 1974) . Marseilles, France, Diffusion Generale de Librairie, 1975;, pp 83-84.
18 +
Barany E:  Ability of retrograde axoplasmatic flow to overcome pressure gradients: Preliminary communication . Doc Ophthalmol Proc Ser 1978;;16:215-219.
19 +
Emery JM, Landis D, Paton D, et al:  The lamina cribrosa in normal and glaucomatous human eyes . Trans Am Acad Ophthalmol Otolaryngol 1974;;78:290-297.
20 +
Maumenee AE:  The pathogenesis of visual field loss in glaucoma , in Brockhurst RJ, Boruchoff SA, Hutchinson BT, et al (eds): Controversy in Ophthalmology . Philadelphia, WB Saunders Co, 1977;, pp 301-311.
21 +
Maumanee AE:  Visual field loss in glaucoma , in Symposium on Glaucoma: Transactions of the New Orleans Academy of Ophthalmology. St Louis, CV Mosby Co, 1981;, pp 160-171.
22 +
Hahnenberger RW:  Effects of pressure on fast axoplasmic flow: An in vitro study in the vagus nerve of rabbits . Acta Physiol Scand 1978;;104:299-308.
23 +
Vrabec F:  Glaucomatous cupping of the human optic disc. A neuro-histologic study . Albrecht Von Graefes Arch Klin Exp Ophthalmol 1976;;198:223-234.
24 +
Anderson DR:  Axonal transport in the retina and optic nerve , in Glaser JS (ed): Neuro-Ophthalmology Symposium of the University of Miami and the Bascom Palmer Eye Institute . St Louis, CV Mosby Co, 1977;, vol 9, pp 140-153.
25 +
Anderson DR:  Papilledema and axonal transport , in Thompson HS, Daroff R, Frisen L, et al (eds): Topics in Neuro-Ophthalmology . Baltimore, Williams & Wilkins Co, 1979;, pp 184-189.
26 +
Radius RL, Anderson DR: The morphology of axonal transport abnormalities in primate eyes. Br J Ophthalmol, in press.
27 +
Radius RL:  Regional specificity in anatomy at the lamina cribrosa . Arch Ophthalmol 1981;;99:478-480.
28 +
Quigley HA, Addicks EM:  Regional differences in the structure of the lamina cribrosa and their relation to glaucomatous optic nerve damage . Arch Ophthalmol 1981;;99:137-143.
29 +
Quigley HA, Addicks EM, Green WR, et al:  Optic nerve damage in human glaucoma: II. The site of injury and susceptibility to damage . Arch Ophthalmol 1981;;99:635-649.
30 +
Geijer C, Bill A:  Effects of raised intraocular pressure on retinal, prelaminar, laminar, and retrolaminar optic nerve blood flow in monkeys . Invest Ophthalmol Vis Sci 1979;;18:1030-1042.
31 +
Sossi N, Anderson DR: Effect of elevated intraocular pressure on blood flow in cat optic nerve head studied with 125I-iodoantipyrine. Arch Ophthalmol, in press.
32 +
Wei EP, Kontos HA, Patterson JL Jr:  Vasoconstrictor effect of angiotensin on pial arteries . Stroke 1978;;9:487-489.
33 +
Edvinsson L, Hardebo JE, Owman CH:  Effects of angiotensin II on cerebral blood vessels . Acta Physiol Scand 1979;;105:381-383.
34 +
Severs WB, Daniels-Severs AE:  Effects of angiotensin on the central nervous system . Pharmacol Rev 1973;;25:415-449.
35 +
Ferrario CM, Gildenberg PL, McCubbin JW:  Cardiovascular effects of angiotensin mediated by the central nervous system . Circ Res 1972;;30:257-262.
36 +
Dollery CT, Hill DW, Hodge JV:  The response of normal retinal blood vessels to angiotensin and noradrenaline . J Physiol 1963;;165:500-507.
37 +
Anderson DR:  Ultrastructure of human and monkey lamina cribrosa and optic nerve head . Arch Ophthalmol 1969;;82:800-814.
38 +
Hayreh SS:  Blood supply of the optic nerve head and its role in optic atrophy, glaucoma, and oedema of the optic disc . Br J Ophthalmol 1969;;53:721.
39 +
Ernest JT, Potts AM:  Pathophysiology of the distal portion of the optic nerve: II. Vascular relationships . Am J Ophthalmol 1968;;66:380-387.
40 +
Francois J, Neetens A:  Vascularization of the optic pathway: I. Lamina cribrosa and optic nerve . Br J Ophthalmol 1954;;38:472-488.
41 +
Henkind P, Levitzky M:  Angioarchitecture of the optic nerve: I. The papilla . Am J Ophthalmol 1969;;68:979-986.
42 +
Levitzky M, Henkind P:  Angioarchitecture of the optic nerve: II. Lamina cribrosa . Am J Ophthalmol 1969;;68:986-996.
43 +
Lieberman MF, Maumenee AE, Green WR:  Histologic studies of the vasculature of the anterior optic nerve . Am J Ophthalmol 1976;;82:405-423.
44 +
Anderson DR:  Vascular supply to the optic nerve of primates . Am J Ophthalmol 1970;;70:341-351.
45 +
Anderson DR, Braverman S:  Reevaluation of the optic disk vasculature . Am J Ophthalmol 1976;;82:165-174.
46 +
Grayson MC, Laties AM:  Ocular localization of sodium fluorescein: Effects of administration in rabbit and monkey . Arch Ophthalmol 1971;;85:600-609.
47 +
Grayson MC, Tsukahara S, Laties AM:  Tissue localization in rabbit and moneky eye of intravenously-administered fluorescein , in Shimizu K (ed): Fluorescein Angiography: Proceedings of the International Symposium on Fluorescein Angiography, Tokyo, 1972 . Tokyo, Igaku Shoin Ltd, 1974;, pp 235-246.
48 +
Cohen AL:  Is there a potential defect in the blood-retinal barrier at the choroidal level of the optic nerve canal? Invest Ophthalmol Vis Sci 1973;;12:513-519.
49 +
Tso MOM, Shih C-Y, McLean IW:  Is there a blood-brain barrier at the optic nerve head? Arch Ophthalmol 1975;;93:815-825.
50 +
Okinami S, Ohkuma M, Tsukahara I:  Kuhnt intermediary tissue as a barrier between the optic nerve and retina . Albrecht Von Graefes Arch Klin Exp Ophthalmol 1976;;201:57-67.
51 +
Olsson Y, Kristensson K:  Permeability of blood vessels and connective tissue sheaths of retina and optic nerve . Acta Neuropathol 1973;;26:147-156.
52 +
Isukahara I, Yamashita H:  An EM study of blood-optic nerve and fluid-optic nerve barrier . Albrecht Von Graefes Arch Klin Exp Ophthalmol 1975;;96:239-246.
53 +
Ernest JT, Archer D:  Fluorescein angiography of the optic disc . Am J Ophthalmol 1973;;75:973-978.
54 +
Ben-Sira I, Riva CE:  Fluorescein diffusion in the human optic disc . Invest Ophthalmol Vis Sci 1975;;14:205-211.
55 +
Douglas GR, Drance SM, Schueltzer M:  The visual field and nerve head in angle-closure glaucoma: A comparison of the effects of acute and chronic angle closure . Arch Ophthalmol 1975;;93:409-411.
56 +
Radius RL, Maumenee AE:  Visual field changes following acute elevation of intraocular pressure . Trans Am Acad Ophthalmol Otolaryngol 1977;;83:61-68.
57 +
Brunner HR, Gavras H:  Is the renin system necessary? Am J Med 1980;;69:739-745.
58 +
Drance SM:  Some factors in the production of low tension glaucoma . Br J Ophthalmol 1972;;56:229-242.
59 +
Drance SM, Morgan RW, Sweeney VP:  Shock-induced optic neuropathy: A cause of non-progressive glaucoma . N Engl J Med 1973;;288:392-395.
60 +
Jampol LM, Board RJ, Maumenee AE:  Systemic hypotension and glaucomatous changes . Am J Ophthalmol 1978;;85:154-159.

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