Normal Tension Glaucoma
A patient with a diagnosis of normal tension glaucoma presented for follow-up in the glaucoma department. Patient had open angles at gonioscopy, with mild hyperopia. At presentation, the intraocular pressure was 12 mmHg in the right eye and 13 mmHg in the left eye under treatment with latanoprost, with a central corneal thickness of 534 µm and 533 µm in the right and left eye, respectively. According to the patient, the intraocular pressure before treatment was around the mid-teens. For medical history, the patient had systemic arterial hypertension, under treatment with losartan. During a 5-year follow-up, the patient maintained intraocular pressures consistently between 10 to 15 mmHg in both eyes with topical intraocular pressure-lowering agents. Despite low intraocular pressure, the patient presented significant glaucomatous progression, with an average rate of loss of -5.0%/year in the visual field index (VFI) and -0.95 dB/year loss in standard automated perimetry mean deviation (MD). During the same time, the patient also presented consistently low systemic arterial pressure, ranging between 112 to 129 mmHg in systolic and 67 to 83 mmHg in diastolic blood pressure. The patient was evaluated for causes of vision loss other than glaucoma, with no secondary cause observed. A review of risk factors for progression indicated low blood pressure during follow-up and nocturnal dips as relevant risk factors. The patient underwent a recent trabeculectomy with mitomycin C in the left eye, targeting single- digit pressure levels to avoid further glaucomatous vision loss.
Presentation Date: 10/24/2024
Issue Date: 11/04/2024
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