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HIGHLIGHTS OF HYPERTENSIVE AND NORMOTENSIVE GLAUCOMA.

J Lešták, Š Pitrová, K Marešová

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    Normotensive glaucoma (NTG) involves anterior optic nerve pathology, with vascular dysfunction significantly impacting visual field changes. Hypertensive glaucoma (HTG) management requires IOP reduction below 20 mmHg, with beta-blockers offering superior visual field protection.

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    Area of Science:

    • Ophthalmology
    • Glaucoma Research
    • Neuro-ophthalmology

    Background:

    • Normotensive glaucoma (NTG) and hypertensive glaucoma (HTG) present distinct pathophysiological mechanisms.
    • Understanding the differences in structural and functional changes is crucial for accurate diagnosis and treatment.
    • Vascular dysfunction is increasingly recognized as a key factor in glaucoma progression.

    Purpose of the Study:

    • To provide an up-to-date overview of NTG and HTG, highlighting their differences.
    • To investigate the role of vascular component (VD) and perfusion parameters in visual field changes in both glaucoma types.
    • To compare the impact of various treatments on intraocular pressure (IOP) and disease progression.

    Main Methods:

    • Review of current literature on NTG and HTG pathogenesis and clinical findings.
    • Analysis of optical coherence tomography angiography (OCTA) results to assess optic nerve head vasculature.
    • Comparison of visual field sensitivity with retinal nerve fiber layer (RNFL) thickness and vascular parameters.

    Main Results:

    • OCT angiography confirms anterior optic nerve pathology in NTG.
    • Vascular dysfunction, particularly in the arteria ophthalmica, significantly contributes to visual field changes in NTG.
    • Perfusion in arteria centralis retinae and retinal nerve fiber layer changes have less impact on visual fields in NTG and HTG.
    • Elevated IOP (>20 mmHg) reduces macular and papillary vascularity.
    • Beta-blockers demonstrate greater visual field protective effects than prostaglandins in HTG treatment.

    Conclusions:

    • Vascular component is a primary driver of visual field defects in NTG.
    • Effective IOP reduction below 20 mmHg is essential for HTG management, with individualized targets based on corneal thickness.
    • Beta-blockers and brimonidine are recommended for NTG treatment, prioritizing posterior pole and anterior optic nerve blood flow.
    • Prostaglandins are less suitable for NTG due to potential negative impacts on IOP reduction, despite their efficacy in HTG.