Korean J Ophthalmol.  2011 Oct;25(5):323-328. 10.3341/kjo.2011.25.5.323.

Short-Term Effects of Ginkgo biloba Extract on Peripapillary Retinal Blood Flow in Normal Tension Glaucoma

• Park JW
• Kwon HJ
• Chung WS
• Kim CY
• Seong GJ

• KMID: 1098634
• DOI: http://doi.org/10.3341/kjo.2011.25.5.323

Abstract

PURPOSE
Based on the vascular theory of glaucoma pathogenesis, we wanted to evaluate the effect of Ginkgo biloba extract (GBE) on peripapillary blood flow in patients with normal tension glaucoma (NTG).
METHODS
Thirty patients with NTG were randomly placed in the GBE-treated or control groups. The GBE-treated group received 80 mg GBE orally, twice a day for four weeks, and the control group received a placebo twice a day for four weeks. Complete ocular examinations including visual field, Heidelberg retina flowmeter, and systemic examinations were performed on the first study day and on the day treatment was completed.
RESULTS
After GBE treatment, the mean blood flow, volume, and velocity increased at almost all points, and there was a statistically significant increase in blood flow at almost all points, in comparison to the placebo. Blood volume significantly increased only in the superior nasal and superior temporal neuroretinal rim areas. GBE also significantly increased blood velocity in areas of the inferior temporal neuroretinal rim and superior temporal peripapillary area.
CONCLUSIONS
GBE administration appears to have desirable effect on ocular blood flow in NTG patients.

Keyword

Ginkgo biloba extract; Heidelberg retina flowmeter; Normal tension glaucoma; Ocular blood flow

MeSH Terms

Aged
Double-Blind Method
Female
*Ginkgo biloba
Humans
Laser-Doppler Flowmetry
Low Tension Glaucoma/*drug therapy/physiopathology
Male
Optic Disk/blood supply
Phytotherapy/*methods
Plant Extracts/*therapeutic use
Regional Blood Flow/*drug effects
Retina/*physiopathology
Retrospective Studies
Time Factors
Visual Fields

Figure

• 

  Fig. 1 Schematic diagram showing locations where perfusion perimeters were measured. 1, Superior nasal peripapillary retina area; 2, inferior nasal peripapillary retina area; 3, superior nasal neuroretinal rim area; 4, inferior nasal neuroretinal rim area; 5, superior optic cup area; 6, inferior optic cup area; 7, superior temporal neuroretinal rim area; 8, inferior temporal neuroretinal rim area; 9, superior temporal peripapillary retina area; 10, inferior temporal peripapillary retina area.

Reference

1. Flammer J, Gasser P, Prunte C. Drance SM, Van Buskirk EM, Neufeld AH, editors. The probable involvement of the factors other than intraocular pressure in the pathogenesis of glaucoa. Pharmacology of glaucoma. 1992. Baltimore: Williams & Wilkins;p. 273–283.

2. Halpern DL, Grosskreutz CL. Glaucomatous optic neuropathy: mechanisms of disease. Ophthalmol Clin North Am. 2002; 15:61–68. PMID: 12064082.

3. Ritch R. Potential role for Ginkgo biloba extract in the treatment of glaucoma. Med Hypotheses. 2000; 54:221–235. PMID: 10790757.

4. DeFeudis FV. Ginkgo biloba extract (EGb 761): pharmacological activities and clinical applications. 1991. Paris: Elsevier.

5. Kleijnen J, Knipschild P. Ginkgo biloba for cerebral insufficiency. Br J Clin Pharmacol. 1992; 34:352–358. PMID: 1457269.

6. Koltringer P, Langsteger W, Klima G, et al. Hemorheologic effects of ginkgo biloba extract EGb 761. Dose-dependent effect of EGb 761 on microcirculation and viscoelasticity of blood. Fortschr Med. 1993; 111:170–172. PMID: 8491438.

7. Wimpissinger B, Berisha F, Garhoefer G, et al. Influence of Ginkgo biloba on ocular blood flow. Acta Ophthalmol Scand. 2007; 85:445–449. PMID: 17324220.

8. Chung HS, Harris A, Kristinsson JK, et al. Ginkgo biloba extract increases ocular blood flow velocity. J Ocul Pharmacol Ther. 1999; 15:233–240. PMID: 10385132.

9. Lee DJ, Ahn HB, Rho SH. The effect of Ginkgo biloba to retinal microcirculation. J Korean Ophthalmol Soc. 2002; 43:1522–1527.

10. Michelson G, Schmauss B, Langhans MJ, et al. Principle, validity, and reliability of scanning laser Doppler flowmetry. J Glaucoma. 1996; 5:99–105. PMID: 8795741.

11. Van Buskirk EM, Cioffi GA. Glaucomatous optic neuropathy. Am J Ophthalmol. 1992; 113:447–452. PMID: 1558122.

12. Levene RZ. Low tension glaucoma: a critical review and new material. Surv Ophthalmol. 1980; 24:621–664. PMID: 7414505.

13. Lee YG, Kim TH, Kim CY, Hong YJ. A comparison of optic nerve head and peripapillary retinal blood flow in normal, primary open angle glaucoma,and normal tension glaucoma. J Korean Ophthalmol Soc. 1999; 40:1934–1943.

14. Kim JJ, Youn JW, Lee HB. The measurement of ocular blood flow velocity using doppler ultrasound in normal tension glaucoma patients. J Korean Ophthalmol Soc. 1996; 37:993–998.

15. Flammer J, Orgul S, Costa VP, et al. The impact of ocular blood flow in glaucoma. Prog Retin Eye Res. 2002; 21:359–393. PMID: 12150988.

16. Harris A, Ciulla TA, Chung HS, Martin B. Regulation of retinal and optic nerve blood flow. Arch Ophthalmol. 1998; 116:1491–1495. PMID: 9823351.

17. Flammer J, Haefliger IO, Orgul S, Resink T. Vascular dysregulation: a principal risk factor for glaucomatous damage? J Glaucoma. 1999; 8:212–219. PMID: 10376264.

18. Flammer J, Pache M, Resink T. Vasospasm, its role in the pathogenesis of diseases with particular reference to the eye. Prog Retin Eye Res. 2001; 20:319–349. PMID: 11286896.

19. Zurakowski D, Vorwerk CK, Gorla M, et al. Nitrate therapy may retard glaucomatous optic neuropathy, perhaps through modulation of glutamate receptors. Vision Res. 1998; 38:1489–1494. PMID: 9667013.

20. Pellegrini-Giampietro DE, Cherici G, Alesiani M, et al. Excitatory amino acid release and free radical formation may cooperate in the genesis of ischemia-induced neuronal damage. J Neurosci. 1990; 10:1035–1041. PMID: 1969465.

21. Dugan LL, Choi DW. Excitotoxicity, free radicals, and cell membrane changes. Ann Neurol. 1994; 35(Suppl):S17–S21. PMID: 8185290.

22. Yoles E, Schwartz M. Potential neuroprotective therapy for glaucomatous optic neuropathy. Surv Ophthalmol. 1998; 42:367–372. PMID: 9493279.

23. Kobayashi MS, Han D, Packer L. Antioxidants and herbal extracts protect HT-4 neuronal cells against glutamate-induced cytotoxicity. Free Radic Res. 2000; 32:115–124. PMID: 10653482.

24. Marcocci L, Maguire JJ, Droy-Lefaix MT, Packer L. The nitric oxide-scavenging properties of Ginkgo biloba extract EGb 761. Biochem Biophys Res Commun. 1994; 201:748–755. PMID: 8003011.

25. Schindowski K, Leutner S, Kressmann S, et al. Age-related increase of oxidative stress-induced apoptosis in mice prevention by Ginkgo biloba extract (EGb761). J Neural Transm. 2001; 108:969–978. PMID: 11716149.

26. Quaranta L, Bettelli S, Uva MG, et al. Effect of Ginkgo biloba extract on preexisting visual field damage in normal tension glaucoma. Ophthalmology. 2003; 110:359–362. PMID: 12578781.

27. Ha SJ, Rho SH. The effects of oral Ginkgo biloba extract on visual field change in patients with NTG. J Korean Ophthalmol Soc. 2003; 44:2047–2057.

28. Park KH. Comparison of optic nerve head blood flow in normal-tension glaucoma with asymmetric visual field loss. J Korean Ophthalmol Soc. 1999; 40:1318–1323.

29. Kim SW, Kim CY, Seong GJ. The short term effects of bimatoprost on optic nerve head and peripapillary retinal blood flow. J Korean Ophthalmol Soc. 2004; 45:1322–1329.