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Léa Benoudis, Sahbi Rouissi, Julie Espenan, Iness Loukil, Amel Jeddi Blouza, Martial Mercie, Nicolas Leveziel, Michèle Boissonnot; Epidemiology and risk factors of progression in primary open-angle glaucoma : a retrospective study of 280 eyes. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4295.
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To assess the epidemiological profile of patients with Primary Open-Angle Glaucoma (POAG) and determine the predictive factors of its progression, in order to screen subjects at risk.
A retrospective study was carried out among 280 eyes of 140 patients with POAG followed at the Ophthalmology Department of University Hospital La Rabta in Tunisia, between 1998 and 2009. After an analysis of their epidemiological profile, eyes were split into two groups: G1 or progression of glaucoma (92 eyes), and G2 or stabilization (188 eyes). Analysed factors of progression were: systemic risk factors, factors related to glaucoma optic neuropathy, other ocular risk factors, and those related to treatment.
The epidemiological characteristics of our patients were high blood pressure (42.9%), diabetes (37.1%), familial history of glaucoma (52.2%), and coronaropathy (17.1%). Ocular parameters were myopia (32.9%), pseudophakic (22.9%), pachymetry < 530 µm (24.2%), ocular hypertension (24.3%), and exfoliation (28.6%). The progression rate of POAG was 32.9%. In univariate analysis, our results concerning factors for glaucoma progression were: initial visual acuity < 0.5 logMAR (Odds Ratio (OR) OR=3.2; p=0.003), long-term fluctuation of intra ocular pressure (IOP) (p=0.003), pachymetry < 505 µm (OR=10.83; p=0.005), noncompliance with therapeutics (OR=7.26; p=0.011), peak in IOP > 23 mmHg (OR=4.5; p=0.02), beta-blockers (p=0.034), bitherapy (OR=3; p=0.03), initial IOP > 25mmHG (OR=5.25; p=0.04), initial cup-to-disc ratio > 5/10 (OR=3.23; p=0.07), Mean Defect (MD) < -8.2 dB (OR=4.8; p=0.07), short-term fluctuation of IOP (p=0.07) and exfoliation (OR=2.84; p=0.053). In multivariate analyses, all factors were interdependant.
These data confirm the complex character of the POAG, either in its epidemiological characteristics or in its progression factors. They point out that the only control of intraocular pressure is not sufficient to guarantee its stabilization. Similary to glaucoma international studies, we found out that numerous parameters are also significant risk factors for progression, mainly low initial visual acuity, long-term IOP fluctuation, thin pachymetry and noncompliance. POAG stabilization is based on identifying high-risk populations to provide them adequate care.
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