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Esther Maria Hoffmann, Jochem Koenig, Anne Contier, Katharina Merz, Norbert Pfeiffer; The role of short-term and long-term intraocular pressure fluctuation on the development and progression of glaucoma. Invest. Ophthalmol. Vis. Sci. 2014;55(13):990.
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Predicting glaucoma progression is a continuing challenge. Elevated intraocular pressure (IOP) is one of the most important risk factors for the development of glaucoma. Clinical trials of glaucoma treatment found that IOP lowering can retard glaucoma progression. However, there is still no consensus as to whether short-term and long-term IOP fluctuation can be considered as independent risk factors for the development of glaucoma and/or glaucoma progression.
Longitudinal IOP profile data (72h IOP profiles), visual field data, optic nerve head and retinal nerve fiber layer data in patients with ocular hypertension and open angle glaucoma have been analyzed at the department of Ophthalmology, Mainz. Data of 380 patients were included. Patients with equal or more than two 72 h IOP profiles, at least 2 images on HRT (HRT 3), equal or mor than 4 visual fields, and at least 2 optic disc stereophotographs were included. Data of clinical and general history, glaucoma history, refraction, visual acuity, surgeries, topical medication, general medication, and pachymetry were recorded. Data are analyzed according to their endpoint "Progresison" defined 1. by visual field and 2. by HRT. Kaplan Meier curves were analyzed. Furthermore, Cox proportional models were build for evaluating risk factors for progression.In this abstract, only results from HRT progression are reported.
Overall, 35 % of all patients showed progression in HRT. Time to progression measured by HRT (in months, m) in patients with primary open angle glaucoma (POAG) was 81.3 m (SE 4.0 m), 71.4 (SE 8.1 m ) in patients with pseudoexfoliation glaucoma (PXE), and 81.3 m (SE 3.6 m) in normal tension glaucoma patients (NTG). IN POAG patients, a higher mean IOP was related to an increased risk for progression (HR 1.07, CI 1.1-1.13, p = 0.03). In normal tension glaucoma patients, long term fluctuation was correlated with a higher risk for progression (HR 2.03, CI 1.10-3.74, p = 0.02). Some HRT parameter (disc area and cup disc ratio) were related with a higher risc for progression.
Intraocular pressure fluctuation seems to be a risc factor for disease progression in patients with normal tension glaucoma. In this longterm follow up, one third of all included patients showed signs of progression on HRT during the study. This analysis therefore, competes with the EMGT results.
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