Abstract
Purpose: :
To evaluate if treated exfoliation glaucoma (XFG) patients with and without a history of severe cardiovascular disease (CVD) progress differently on he long run.
Methods: :
Retrospective, multi-center, observational cohort analysis was performed in 8 university eye centers in 8 European countries. XFG patients with a minimum of five-year follow-up were included in the study based on consecutive charts. One eye per patient was analyzed. Selection of the study eye was randomized if both eyes were eligible. Progression of glaucoma was determined clinically by the investigators using identical structural and functional criteria.
Results: :
201 patients were included in the analysis. No difference was found in baseline demographics between stable (n=86) and progressed (n=117) patients. A statistically significant difference was found between progressed and stable patients in long-term mean IOP (19.2 ± 4.6 mm Hg vs. 17.6 ± 3.6 mm Hg, Student's t-test, p=0.005), peak IOP (23.2 ± 7.4 mm Hg vs. 21.0 ± 5.6 mm Hg, p=0.015) and IOP variability expressed as variance of all IOP values during the follow-up (21 vs. 13 mm Hg, F-test, p=0.028) as well as the number of medicine changes per year (0.5 ± 1.1 vs. 0.2 ± 0.3, Student's t-test, p=0.004). At a long-term mean IOP ≥22 mm Hg patients progressed in 84.2 % (32/38), at mean IOP between 14 and 21 mm Hg in 53.6% (81/151) and at mean IOP ≤13 mm Hg in 33.3% (4/12). There was no difference in the rate of progression between the groups based on CVD history (p=0.650). However, the IOP that allowed an approximately ≤50% progression rate for patients with mild or no CVD was ≤20-21 mm Hg but only approximately ≤18 mm Hg for patients with severe CVD. Further, at long-term mean IOP ≥20 mm Hg 8 % (1/12) of the patients with severe CVD remained stable in contrast to 38% (16/42) of patients with mild CVD and 21% (4/19) with no CVD history (Chi square test, p=0.009). By multivariant regression analysis of all IOP and CVD measures, only long-term mean IOP was a significant as a risk factor for progression (p=0.010).
Keywords: intraocular pressure • visual fields