Effect of Triflusal on Primary Vascular Dysregulation Compared with Aspirin: A Double-Blind, Randomized, Crossover Trial

PURPOSE: Primary vascular dysregulation (PVD) is a condition in which the response to cold temperature or external stimuli is abnormal. We investigated whether triflusal use results in amelioration of PVD symptoms and improvement of several related parameters compared with aspirin. MATERIALS AND METHODS: Eighty-eight PVD patients (54% female, 56+/-8 years) were randomly selected to receive either triflusal (300 mg, b.i.d.) or aspirin (150 mg, b.i.d.) for a period of 6 weeks followed by crossover. PVD was defined as both red-blood-cell standstill in video-assisted microscopic capillaroscopy during cold stimulation using carbon dioxide gas and a score of more than 7 points in a validated questionnaire. Efficacy of treatment was assessed by 1) cold intolerance symptom severity (CISS) score, 2) finger Doppler indices, and 3) indocyanine green perfusion imaging. RESULTS: The use of triflusal resulted in a greater improvement in CISS score (44.5+/-18.4 vs. 51.9+/-16.2; p<0.001) and in mean radial peak systolic velocity (69.8+/-17.2 vs. 66.1+/-16.4; p=0.011) compared to aspirin. Furthermore, significant differences were also observed in perfusion rates on indocyanine green perfusion imaging between triflusal and aspirin (45.6+/-25.8 vs. 51.6+/-26.9; p=0.020). CONCLUSION: Triflusal was more effective and demonstrated a more consistent impact on the improvement of symptoms and blood flow in patients with PVD than aspirin.

Comparision of Primary Vascular Dysregulation for Unilateral and Bilateral Eye Involvement in Normal Tension Glaucoma

PURPOSE: To compare the clinical symptoms and signs of primary vascular dysregulation (PVD) for unilateral and bilateral eye involvement in normal tension glaucoma (NTG). METHODS: The authors administered a questionnaire to assess PVD in patients with NTG. The answers to the 10-item questionnaire (cold hands, migraine, sleep latency, thirst, hypotension, orthostatic hypotension, emotional stress, drug sensitivity, vertigo, and systemic vasospasm) were compared between patients with unilateral involved NTG and bilateral involved NTG (N=61). The groups were classified again according to age (criteria: 55 years), sex, and mean deviation via standard automated perimetry (criteria: -6 dB). RESULTS: The answers to the questionnaire between patients with unilateral involved NTG and bilateral involved NTG were not different at the level of statistical significance. In groups classified according to age, sex, and mean deviation, none of the answers to the questionnaire were different at the level of statistical significance between the groups. CONCLUSIONS: Clinical symptoms and signs of PVD were not different between patients with unilateral or bilateral eye involvement in NTG. Systemic vascular factors may not be considered different between unilateral and bilateral eye involvement in NTG.

Comparison of Primary Vascular Dysregulation in Normal Tension Glaucoma and Primary Open Angle Glaucoma

PURPOSE: To evaluate the clinical symptoms or signs of primary vascular dysregulation (PVD) in patients with normal tension glaucoma (NTG) and primary open-angle glaucoma (POAG). METHODS: From June 2008 to June 2009, we administered questionnaires to patients with glaucoma. The questionnaire was composed of 11 items, and the questionnaire results were compared between patients with NTG and POAG. NTG patients were subdivided by age(criterion: 55 years) and perimetric mean deviation (criterion: -6dB). RESULTS: We detected a significant increase in hypotension (p=0.036) in NTG patients (n=133), compared to POAG patients (n=68). Migraines and emotional stress were more frequent in younger patients (55 years) with NTG (27.5%, 42.9%, p=0001). The frequency of drug sensitivity and systemic vasospasm is higher in older patients with NTG (28.6%, 17.4%) than younger patients with NTG (12.9%, 4.9%) but the rate of systemic vasospasm is much higher in younger patients, compared to the prevalence in the general Korean population. In patients with moderate and advanced NTG, hypotension is highly prevalent (p=0.018). CONCLUSIONS: Hypotension is a greater risk factor for NTG than for POAG. Indeed, vascular factors may be correlated with NTG, especially in younger patients with moderate, advanced visual field defects.