Posters

Diagnostic approach to normal tension glaucoma: a case report

Poster Details

First Author: A.Nowrouzi SPAIN

Co Author(s):    J. Benitez-del-Castillo   I. Mota-Chozas                 

Abstract Details

Purpose:

To show the ordered diagnostic process in case of suspected normal tension glaucoma (NTG)

Setting:

Hospital Universitario de S.A.S. de Jerez (Spain)

Methods:

A clinical case of documented functional (visual field) and structural (peripapillary retinal nerve fiber layer thickness and optic nerve head tomography measured with optical coherence tomography) glaucoma with normal intraocular pressure (IOP) (Goldmann applanation tonometry) in the morning time slot without treatment is subjected to a systematic series of diagnostic procedures: detailed personal and family history (vascular history), pachymetry, diurnal IOP curve, polysomnography, cardiovascular study (blood pressure and heart rate) thyroidal and coagulation abnormalities (TSH ,T4 , PT, PTT, BT, anticardiolipin aB), intracraneal imaging and vascular studies (carotid and lower limbs doppler echography) and macular and peripapillary angio-OCT.

Results:

Normal IOP values in diurnal IOP curve without treatment (max: 18-20 mmHg) discarding higher IOPs out of office; U.S. pachymetry 515/520 microns and normal IOP with PASCAL tonometer (no corneal biomechanical subestimation); normal polysomnography study excluding Sleep Apnea Syndrome (SAS). Normal serial BP ruled out the possibility of systemic hypotension. Thyroidal and coagulation abnormalities were excluded by normal TSH, T4, PT, PTT, BT and anticardiolipin antibody. Normal brain MRI and normal carotid vascular study. But peripheral arterial disease in lower limbs was confirmed by echography.

Conclusions:

The etiopathogenesis of glaucomatous optic neuropathy is quite complex: it can be associated with normal levels of IOP. Peripheral vascular disease is an important risk factor for NTG. But NTG is still a “diagnosis of exclusión”.

Financial Disclosure:

None