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Diabetic macular oedema was associated with T2DM (P?UNC2881 been referred to the ��pressure in the eye��, although in a strictly physically meaning, the ophthalmologic term ��intraocular pressure�� only describes the transcorneal pressure difference between the intraocular space and the extraocular surrounding air. An eye with an ��intraocular pressure�� of 20?mmHg thus has a physically correctly defined pressure of 780?mmHg as sum of the atmospheric pressure (760?mmHg) plus 20?mmHg. For more than 150?years, the intraocular pressure (IOP) defined as transcorneal pressure difference has been considered to be the main risk factor in the pathogenesis of glaucoma. It is, however, the trans-optic nerve head pressure difference that directly affects the optic nerve head (Fig.?1).1,2 It is defined pressure in the intraocular compartment minus pressure in the retrobulbar cerebrospinal fluid space (orbital cerebrospinal fluid pressure [CSF-P]). Taking into the orbital CSF-P as counter-pressure against the IOP, hypotheses may be formed on the pathogenesis of optic nerve head diseases such as glaucoma, retinal vein occlusions and arterial hypertensive retinopathy. The first hypothesis is that a low orbital CSF-P is associated with the pathogenesis of glaucomatous optic neuropathy. If IOP is normal and orbital CSF-P is abnormally low, the trans-lamina cribrosa pressure difference is increased. It leads to a similar situation as if the IOP is elevated and orbital CSF-P is normal. The situation described first would be normal-(intraocular-)pressure glaucoma. The situation described last is high-(intraocular-)pressure glaucoma. Accordingly, experimental studies and clinical studies suggested that the CSF-P is abnormally low in patients with normal-(intraocular-)pressure glaucoma.3�C5 The CSF-P is physiologically correlated with IOP and arterial blood pressure, which is correlated with IOP, so that the pressures in all three fluid-filled compartments (arterial blood system, brain and intraocular space) are correlated with each other. Previous studies showed an association between normal-(intraocular-)pressure glaucoma, low systemic arterial blood pressure and low body mass index. The hypothesis is that in normal-(intraocular-)pressure glaucoma, a low arterial blood pressure is associated with a more marked reduction in CSF-P than reduction in IOP. It results in an increased trans-lamina cribrosa pressure difference, similar as if the IOP is elevated as in high-(intraocular-)pressure glaucoma.