J Korean Ophthalmol Soc > Volume 55(7); 2014 > Article
Journal of the Korean Ophthalmological Society 2014;55(7):1030-1038.
DOI: https://doi.org/10.3341/jkos.2014.55.7.1030    Published online July 15, 2014.
Relationship among Water-Shed Zone, Nocturnal Dip and Visual Field Progression in Open Angle Glaucoma.
Hong Ryung Seo, Nam Yeong Kim, Sae Heun Rho
1Department of Ophthalmology, Wallace Memorial Baptist Hospital, Busan, Korea.
2Department of Ophthalmology, Dong-A University College of Medicine, Busan, Korea. shrho@dau.ac.kr
개방각녹내장에서 맥락막분수계역, 야간 혈압하강 및 녹내장성 시야결손의 상관관계
서홍융1⋅김남영2⋅노세현2
Department of Ophthalmology, Wallace Memorial Baptist Hospital1, Busan, Korea Department of Ophthalmology, Dong-A University College of Medicine2, Busan, Korea
Abstract
PURPOSE
To investigate the influence of water-shed zone (WSZ) and nocturnal dip (ND) on the progression of the glaucomatous visual field (V/F) defects in open-angle glaucoma (OAG) patients when the intraocular pressure (IOP) was maintained under the target pressure. METHODS: We performed fluorescence angiography (FAG), 24-hour ambulatory blood pressure monitoring (24-hr ABPM), and V/F tests. We examined the relationships among WSZ in early-FAG, ND over 10% (dip), and the progression of the glaucomatous V/F defects using chi-square, Fisher's exact, and multivariate logistic regression tests. A p-value < 0.05 was considered statistically significant. RESULTS: When considering the correlation between WSZ and dip, statistical significance was found in OAG (p = 0.024, odds ratio (OR) = 3.308) and normal tension glaucoma (NTG) (p = 0.029, OR = 4.364) patients. In patients with dip, glaucomatous V/F defects significantly progressed (OAG: p = 0.003, OR = 5.938, NTG: p = 0.005, OR = 13.929). In patients with WSZ, the glaucomatous V/F defects progressed in all groups (OAG: p = 0.002, OR = 5.156, NTG: p = 0.024, OR = 4.750, primary open angle glaucoma (POAG): p = 0.021, OR = 8.750). In the patients with WSZ involving optic nerve head, the glaucomatous V/F defects had progressed in OAG (p = 0.004, OR = 5.958) and NTG (p = 0.009, OR = 8.333) groups. Based on binary logistic regression analysis, dip (p = 0.010, OR = 6.227) significantly affected V/F progression only in OAG patients. CONCLUSIONS: In the OAG and NTG groups, ND over 10% influenced the progression of the glaucomatous V/F defects. The patients with WSZ tended to have ND over 10% in OAG and NTG groups and glaucomatous V/F defects progressed in all patients. Therefore, performing early FAG and 24-hr ambulatory blood pressure monitoring may be helpful for glaucoma patients with progressing glaucomatous V/F defects even when the IOP was maintained under the target pressure.
Key Words: Nocturnal dip;Progression of the glaucomatous visual field defects;Twenty-four-hour blood pressure monitoring;Vascular dysregulation;Water-shed zone


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