Intraocular pressure reduction in normal-tension glaucoma patients in South Korea

Siloam Eye Hospital, Gangseo-gu, Seoul, South Korea.
International Ophthalmology (Impact Factor: 0.55). 09/2011; 31(5):355-61. DOI: 10.1007/s10792-011-9463-7
Source: PubMed


To evaluate the potential benefit of intraocular pressure (IOP) reduction in normal-tension glaucoma (NTG) patients in South Korea. A retrospective, multi-center analysis of Korean NTG patients with 5-years follow-up, typical glaucomatous optic disc and/or visual field changes and no recorded IOP >21 mmHg. Progression was identified by Advanced Glaucoma Intervention Study visual field scoring. There were 90 (42%) progressed patients and 127 (58%) stable patients included in the study. Mean IOP measured higher in the progressed (14.3 ± 2.2 mmHg) than stable patients (14.0 ± 1.9 mmHg), but was not statistically different between the groups (P = 0.29). The mean IOP that best discriminated stable patients was ≤15 mmHg, but no statistical difference existed in the numbers of progressed versus stable patients at ≤15 mmHg compared to >15 mmHg (P = 0.07). Multivariate regression analysis showed that the baseline number of glaucoma medicines and visual field as well as mean, peak and fluctuation of IOP were significant risk factors for glaucomatous progression (P < 0.01). This study suggests that in Korean NTG patients, despite relatively similar IOPs between progressed and stable patients, and based on multivariate regression analysis, IOP may be a risk factor for glaucomatous progression.

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    ABSTRACT: Purpose: To determine the risk factors of visual field (VF) progression in relatively low and high intraocular pressure (IOP) groups in normal tension glaucoma (NTG) patients and to compare progression rate of VF defects between the 2 groups. Methods: Forty-nine eyes of 49 NTG patients with untreated IOP of ≤15 mm Hg (group A) and 49 eyes of 49 NTG patients matched by age and baseline VF mean deviation (MD) who had untreated IOP of >15 mm Hg (group B) were included in this retrospective chart review study. All patients were followed >5 years. Risk factors for VF progression were evaluated using Cox proportional hazards models in each group, separately. Changes in VF indexes were compared between the 2 groups. Results: Mean IOP and IOP fluctuation were significantly greater in group B than in group A (P<0.001 and P=0.016), whereas other factors did not differ between the groups. In multivariable analysis, VF progression was significantly associated with disc hemorrhage in group A (HR, 6.19; P=0.017) and mean IOP in group B (HR, 1.77; P=0.029). There was no significant difference between the groups in incidence of progression and in changes of MD, pattern SD, and VF index (P=0.942, 0.874, and 0.887, respectively). Conclusions: Although progression rate was similar, the risk factors for VF progression were different in the 2 groups. These findings may suggest that IOP-dependent and IOP-independent factors affect VF progression differently in the 2 groups.
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