2020 - 5 Issue

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Highlights of Hypertensive and Normotensive Glaucoma

Ján Lešták ORCID
Šárka Pitrová ORCID – Klára Marešová ORCID

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DOI: 10.31348/2020/31

Published in Czech and Slovak Ophtalmology: 2020 - 5

Published on website: 20.12.2020

Keywords: glaukomy, OCT angiografie, antiglaukomatosní léčba prostaglandiny a betablokátory

Summary

The paper presents the up-to-date overview of pathogenesis, functional and structural changes in normotensive glaucoma (NTG) and its differences from hypertensive glaucoma (HTG).

The autors point out new facts that distinguish both diagnostic groups. In the first place are the results of OCT angiography, which verify the pathology of NTG to the anterior part of optic nerve.

Our findings confirmed that vascular component (VD) is more involved in changes of visual field than in perfusion parameters, especially in arteria ophtalmica (AO). Perfusion in arteria centralis retinae (ACR) does not play a significant role in NTG changes in the visual field.

VD has very little effect on changes in visual field in HTG. Similarly, the retinal nerve fiber layer (RNFL) for changes in the visual field. Howerver, VD is moderately influenced by changes in RNFL. It should be emphasized that we compared the sum of sensitivity in the central part of the visual field (0-22 degrees) with RNFL and VD. In NTG, the anterior part of the optic nerve is altered. Mainly VD contributes to visual field changes in NTG. It is also important to note that when the intraocular pressure (IOP) increased above 20 mm Hg, the macular and papillary VD was significantly reduced.

Antiglaucomatous treatment with prostaglandins and beta-blockers is essential for the reduction of IOP in HTG. This reduction shoud be bellow 20 mm Hg, in eyes with thinner cornea the decrease in IOP should be more pronounced. It does not matter which antiglaucoma treatment was used. However, it should be noted that prostaglandins have a greater effect on disease progression, but the greater protective effect on the visual field have beta-blockers. Neuroprotectives should be recommended systemically in patients with HTG.

When treating NTG, it is important to maintain blood flow of the posterior pole of the eye, but mainly of the anterior part of the optic nerve. Prostaglandins are not suitable in NTG patients, although their effect on IOL reduction is high. Beta-blockers (betaxolol and carteol) and brimonidine are most suitable. Corneal thickness has no effect on disease progression.

References

  1. Our findings confirmed that the vascular component of VD contributes to changes in the visual fields in NTG to a greater degree than perfusion parameters, especially in the AO. Perfusion in the ACR does not play a significant role in changes in the visual field in NTG.
  2. VD has very little influence on changes in the visual fields in HTG. The same applies to the retinal nerve fibre layer (RNFL) on changes in the visual field. However, VD has a medium strength influence on changes in the RNFL. Here it is necessary to emphasise that we compared the sum of sensitivities in the central part of the visual field (0-22 degrees) with the RNFL and VD. In NTG an alteration of the anterior part of the optic nerve takes place. VD has a greater share in changes in the visual fields in NTG. However, it is important to state that when intraocular pressure (IOP) increased above 20 mmHg, macular and papillary VD was significantly reduced.
  3. Antiglaucomatous treatment by prostaglandins and beta-blockers is of fundamental significance for reducing IOP in HTG. This reduction should be below 20 mmHg, in eyes with a thinner cornea the reduction of IOP should be more pronounced. It is not of fundamental significance as to which antiglaucomatous agents are used. It is nevertheless necessary to point to the fact that prostaglandins have a greater influence on the progression of the pathology. Beta-blockers have a greater protective effect on the visual field. In patients with HTG it is appropriate to recommend neuroprotective agents systemically.
  4. In the treatment of NTG it is important to preserve blood perfusion of the posterior pole of the eye, but above all of the anterior part of the optic nerve. Prostaglandins are not suitable for patients with NTG, even if they have a large influence on reducing IOP. The most appropriate drugs are beta-blockers (betaxolol and carteol) and brimonidine. Corneal thickness has no influence on the progression of the pathology.
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