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Amitabha S Bhakta, Arindel Maharaj, David S Greenfield; Association between nocturnal hypotension and optic disc hemorrhage in glaucomatous eyes. Invest. Ophthalmol. Vis. Sci. 2017;58(8):745. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Low diastolic perfusion pressure is an established risk factor for glaucoma onset and progression. The purpose of this study was to prospectively examine 24-hour blood pressure (BP) and daytime mean ocular perfusion pressure (MOPP) in glaucomatous eyes with and without optic disc hemorrhage (ODH).
Open-angle glaucoma patients meeting enrollment criteria were prospectively enrolled. Baseline examination consisted of complete ocular exam, standard automated perimetry, optic disc photography. Eyes were classified based upon the presence (DH) or absence (NDH) of disc hemorrhage. All oral and ophthalmologic medications were recorded. Patients had their systemic BP monitored every 60 minutes for 24 hours using an ambulatory recording device (Welch Allyn ABPM 6100, Skaneateles Falls, NY). Diurnal BP measurements were defined as recordings from 8 AM - 9 PM; nocturnal measurements from 10 PM - 7 AM. Nocturnal hypotension was defined as ≥ 10 mmHg difference between mean diurnal and mean nocturnal mean arterial pressure (MAP). In-office daytime IOP and seated BP measurements were obtained at four time points (8:00 AM, 10:00 AM, 12:00 PM, and 4:00 pm) and MOPP was calculated [2/3 MAP – IOP].
Twenty-three eyes of 23 patients were enrolled (15 NTG, 8 POAG) Ten patients were classified as having DH at enrollment; 13 patients had NDH. Mean age (75.4 ± 7.1 vs 71.4 ± 9.0 yrs; p = 0.24) and visual field mean deviation (-5.5 ± 4.0 vs -6.5 ± 6.7 dB; p = 0.65) were similar between the DH and NDH groups, respectively. Mean daytime IOP (12.3 ± 1.6 mmHg, 12.5 ± 2.6 mmHg, p =0.86), MAP (91.6 ± 8.6, 93.6 ± 8.1 mmHg; p = .59) and MOPP (53.9 ± 5.4, 54.7 ± 4.6 mmHg; p = 0.70) were similar between the DH and NDH groups, respectively. Nocturnal MAP was lower (79.0 ± 7.1 vs 87.9 ± 14.3 mmHg, p = .07) in the DH group. Nocturnal hypotension was observed in 8 of 10 (80%) DH patients compared to 4 of 13 (30.8%) NDH patients (p = .04).
Glaucomatous eyes with DH are associated with reduced nocturnal MAP which may contribute to the pathogenic mechanism of impaired optic nerve perfusion.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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