Citation:Hopf S,Schwantuschke D,Schmidtmann I,Pfeiffer N,Hoffmann EM.Impact of intraocular pressure fluctuations on progression of normal tension glaucoma.Int J Ophthalmol 2021;14(10):1553-1559,doi:10.18240/ijo.2021.10.12
Impact of intraocular pressure fluctuations on progression of normal tension glaucoma
Received:December 16, 2020  Revised:April 25, 2021
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DOI:10.18240/ijo.2021.10.12
Key Words:intraocular pressure  intraocular pressure fluctuation  glaucoma progression  visual field  optical  optical coherence tomography
Fund Project:Supported by a DFG (German Research Foundation) Grant (HO 3277/2-1).
              
AuthorInstitution
Susanne Hopf Department of Ophthalmology, University Medical Center Mainz, Mainz 55131, Germany
Doris Schwantuschke Pediatric Dentistry, Nieder-Olm 55268, Germany
Irene Schmidtmann Institute of Medical Biostatistics, Epidemiology and Informatics IMBEI, University Medical Center Mainz, Mainz 55131, Germany
Norbert Pfeiffer Department of Ophthalmology, University Medical Center Mainz, Mainz 55131, Germany
Esther Maria Hoffmann Department of Ophthalmology, University Medical Center Mainz, Mainz 55131, Germany
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Abstract:
      AIM: To investigate short- and long-term intraocular pressure (IOP) fluctuations and further ocular and demographic parameters as predictors for normal tension glaucoma (NTG) progression.

    METHODS: This retrospective, longitudinal cohort study included 137 eyes of 75 patients with NTG, defined by glaucomatous optic disc or visual field defect with normal IOP (<21 mm Hg), independently from therapy regimen. IOP fluctuation, mean, and maximum were inspected with a mean follow-up of 38mo [standard deviation (SD) 18mo]. Inclusion criteria were the performance of minimum two 48-hour profiles including perimetry, Heidelberg retina tomograph (HRT) imaging, and optic disc photographs. The impact of IOP parameters, myopia, sex, cup-to-disc-ratio, and visual field results on progression of NTG were analyzed using Cox regression models. A sub-group analysis with results from optical coherence tomography (OCT) was performed.

    RESULTS: IOP fluctuations, average, and maximum were not risk factors for progression in NTG patients, although maximum IOP at the initial IOP profile was higher in eyes with progression than in eyes without progression (P=0.054). The 46/137 (33.5%) eyes progressed over the follow-up period. Overall progression (at least three progression confirmations) occurred in 28/137 eyes (20.4%). Most progressions were detected by perimetry (36/46). Long-term IOP mean over all pressure profiles was 12.8 mm Hg (SD 1.3 mm Hg); IOP fluctuation was 1.4 mm Hg (SD 0.8 mm Hg). The progression-free five-year rate was 58.2% (SD 6.5%).

    CONCLUSION: Short- and long-term IOP fluctuations do not result in progression of NTG. As functional changes are most likely to happen, NTG should be monitored with visual field testing more often than with other devices.

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