Reversible visual field loss in glaucoma following ventriculoperitoneal shunting for normal pressure hydrocephalus

We report a case of visual field deterioration in previously stable open-angle glaucoma which resolved upon ventriculoperitoneal shunting (VPS) for coexisting normal pressure hydrocephalus (NPH). A woman in her 80s with bilateral open-angle glaucoma developed apparent progression of existing glaucomatous field defects, despite stable disease and consistent intraocular pressure control following bilateral trabeculectomies over a decade prior. She was concurrently diagnosed with NPH and underwent VPS. Following VPS, visual fields returned to a previously stable baseline.Visual field fluctuations may occur concurrently with NPH, a condition affecting intracranial pressure (ICP). Here, we report visual field worsening temporally associated with NPH onset and a rare association between VPS and field improvement in the context of prior trabeculectomy. VPS may improve visual fields in post-trabeculectomy eyes by reducing ICP, thereby narrowing the translaminar pressure gradient. Unexplained visual field changes in well-controlled glaucoma should prompt consideration of pathologies affecting ICP.