Incidence of elevation of intraocular pressure over time and associated factors in normal-tension glaucoma

Purpose: The authors determine whether intraocular pressure (IOP) increases to levels that challenge the diagnosis of normal-tension glaucoma (NTG) and determine clinical factors associated with the IOP elevation. Methods: Forty patients with NTG who met the following enrollment criteria were selected: IOPs less than 21 mm Hg during initial 24-hour pressure curve and throughout the subsequent 12 months; examined every 1 to 4 months for at least 4 years; and no ocular hypotensive treatment. The eye with the higher mean IOP during the initial 24-hour pressure curve was selected from each patient. The observation period ranged from 4.0 years to 7.8 years (mean, 5.2 years). Significant IOP elevation was defined as a significant increase (p < 0.05) of IOP over time, determined by Spearman rank correlation coefficient method. The IOP elevation was correlated to clinical factors by means of a logistic multiple regression analysis (LOGIST procedure using PC-SAS, SAS Institute, Inc. Cary, NC, U.S.A.). Results: Eleven eyes were rated positive for IOP elevation. The regression model demonstrated that maximum IOP during the initial 24-hour pressure curve and the development of disc hemorrhage (DH) were significantly correlated with IOP elevation(p = 0.006 and p = 0.049, respectively). The odds ratios calculated were 1.98 per 1 mm Hg rise of maximum IOP during the initial 24-hour pressure curve and 6.54 for positive DH. Conclusions: Intraocular pressure might increase in NTG eyes following the initial diagnosis. A higher maximum IOP during initial 24-hour pressure curve and the development of DH during follow-up was significantly associated with subsequent IOP elevation in NTG patients.