May 2007
Volume 48, Issue 13
Free
ARVO Annual Meeting Abstract  |   May 2007
Target Pressure Determined in Progressive Normal-Tension Glaucoma Cases
Author Affiliations & Notes
  • A. Aoyama
    Ophthalmology, Gifu Graduate School of Medicine, Gifu, Japan
  • K. Ishida
    Ophthalmology, Gifu Graduate School of Medicine, Gifu, Japan
  • T. Yamamoto
    Ophthalmology, Gifu Graduate School of Medicine, Gifu, Japan
  • Footnotes
    Commercial Relationships A. Aoyama, None; K. Ishida, None; T. Yamamoto, None.
  • Footnotes
    Support None.
Investigative Ophthalmology & Visual Science May 2007, Vol.48, 1265. doi:https://doi.org/
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    • Get Citation

      A. Aoyama, K. Ishida, T. Yamamoto; Target Pressure Determined in Progressive Normal-Tension Glaucoma Cases. Invest. Ophthalmol. Vis. Sci. 2007;48(13):1265. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose:: To determine a target IOP level in progressive normal-tension glaucoma (NTG) by evaluating visual field (VF) progression following trabeculectomy.

Methods:: All consecutive cases (164 eyes of 115 patients) with NTG who underwent trabeculectomy with mitomycin C between 1990 and 2000, were retrospectively reviewed and 40 eyes of 40 patients who had significant progression of VF preoperatively, were selected based on the following criteria: best-corrected visual acuity >20/30, preoperative mean deviation (MD) >-20.00 dB, no eye diseases except NTG or postoperative complications which may affect VF, and postoperative follow-up period > 5 years (mean 12 years, range; 5.3-16.0 yrs). Perimetric examination was periodically performed and progression was determined by two criteria: AGIS score deteriorated at least four, and significant negative MD slope by a linear regression model. Kaplan-Meier method was used to compare the VF stability in different IOP levels. Preoperative mean MD was -13.38dB.

Results:: The IOP was reduced from 15.2 to 9.4 mmHg in average by trabeculectomy (p<.0001). IOP≤10 was attained in 60% of cases. 30% and 20% reduction of IOP were achieved in 23 (58%) and 29 (73%) of 40 patients, respectively. Cumulative probability of postoperative VF stability defined by the AGIS criterion was 96 % at 14 year-F/U in patients who achieved 30% reduction of IOP, whereas it was 32 % in ones who did not (p<.0001: Logrank test). When 20% IOP reduction was employed as a cut-off value, VF was maintained in 93% in the successfully controlled group, but all cases who failed showed progression (p<.0001). When IOP values such as 8, 9, 10, 11, 12 mmHg were employed as a cut-off, the best VF prognosis was attained by both progression criteria in cases with the postoperative IOP value of 10 mmHg. However, 8 % of patients with postoperative IOP≤10 mmHg and/or achieved 30% reduction of IOP still had VF progression.

Conclusions:: At least 20% reduction of IOP or IOP≤10 mmHg is required as postoperative target IOP in NTG patients who had significant progression of VF preoperatively.

Keywords: clinical (human) or epidemiologic studies: risk factor assessment • intraocular pressure • visual fields 
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