개방각녹내장에서 맥락막분수계역, 야간 혈압하강 및 녹내장성 시야결손의 상관관계

Relationship among Water-Shed Zone, Nocturnal Dip and Visual Field Progression in Open Angle Glaucoma

<b>Purpose:</b> 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. <b>Methods:</b> 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 &lt; 0.05 was considered statistically significant. <b>Results:</b> When considering the correlation between WSZ and dip, statistical significance was found in OAG (<em>p</em> = 0.024, odds ratio (OR) = 3.308) and normal tension glaucoma (NTG) (<em>p</em> = 0.029, OR = 4.364) patients. In patients with dip, glaucomatous V/F defects significantly progressed (OAG: p = 0.003, OR = 5.938, NTG: <em>p</em> = 0.005, OR = 13.929). In patients with WSZ, the glaucomatous V/F defects progressed in all groups (OAG: <em>p </em>= 0.002, OR = 5.156, NTG:<em> p</em> = 0.024, OR = 4.750, primary open angle glaucoma (POAG): <em>p</em> = 0.021, OR = 8.750). In the patients with WSZ involving optic nerve head, the glaucomatous V/F defects had progressed in OAG (<em>p </em>= 0.004, OR = 5.958) and NTG (<em>p</em> = 0.009, OR = 8.333) groups. Based on binary logistic regression analysis, dip (<em>p</em> = 0.010, OR = 6.227) significantly affected V/F progression only in OAG patients. <b>Conclusions:</b> 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. J Korean Ophthalmol Soc 2014;55(7):1030-1038