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Mika Harju, Leena Kurvinen, Sakari Suominen, Eija T. Vesti; Reversal Of Cupping After Intraocular Pressure Reduction In Exfoliation And Normal Tension Glaucoma. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5111.
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To study the change in optic nerve head (ONH) topography after reduction of intraocular pressure (IOP) in exfoliation glaucoma (ExG) and normal tension glaucoma (NTG).
Included were 20 eyes of 20 patients (median age 73 years; range 53-84 years) with ExG and 24 eyes of 24 patients (age 67 years; 53-86 years) with NTG before deep sclerectomy performed.Scanning laser ophthalmoscopy of the ONH was performed with the Heidelberg Retina Tomograph (HRT) before and three months after the operation.
Three months after deep sclerectomy, median (range) IOP was significantly reduced in ExG eyes from 24 (16-33) mmHg to 13 (4-18) mmHg (p<0.001) and in NTG from 15 (11-20) mmHg to 10 (3-20) mmHg (p<0.001). The eyes with IOP reduction of 30% or more were included in HRT analysis In ExG eyes (n=17) most HRT parameters showed a significant change (improvement) after the operation compared to pre-operative values (Table 1). In NTG eyes (n=20) HRT parameters were comparable before and after the operation. In NTG eyes with IOP reduction of 6 mmHg or more, RV was significantly increased, and the increase in RA and RNFLCSA, and the decrease in CA and CV were of borderline significance (Table 2).
A marked IOP reduction will cause changes in the HRT parameters indicating cup reversal in eyes with high-pressure glaucoma, and also in low-tension glaucoma if the absolute IOP reduction is large enough. IOP changes should be accounted for when using HRT for follow-up of the ONH.
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