normal tension glaucoma ntg
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NORMAL TENSION
GLAUCOMA-NTG
Ameerhamza S B 7th term
SIMS , Shimoga
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Normal tension glaucoma / low tension glaucoma
Typical glaucomatous disk changes and visual field defects
Intraocular pressure constantly below 21mmHg
The angle of the anterior chamber is open on gonioscopy
No secondary cause for glaucomatous disk changes
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Chronic low vascular perfusion makes optic nerve susceptible for normal IOP
This view is supported by - Raynaud phenomenon - Migraine - Nocturnal systemic hypotension and overtreated hypertension - Reduced blood flow velocity in Ophthalmic A.
Etiopathogenesis
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IOP : consistently lower than 21mmHgOptic disc changes : Are similar to POAG with following special features - Thinning of neuroretinal rim - Flame shaped haemorrhages of the optic nerve rim (Drance haemorrhage) - Deep, focal notching of the rim - Peripapillary atrophy
Clinical Features
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Visual Field Defects : Similar to POAG but more deeper,steeper,more localised and closure to fixation point
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DD’s
High pressure glaucomas
POAG
Glaucoma with intermittent rise in IOP
Previous episodes of Glaucoma
Non glaucomatous optic neuropathies
Congenital optic disc anomalies
Acquired optic neuropathies
Differential Diagnosis
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1. Medical Treatment to lower IOP
“Aim is to lower IOP by 30% i.e. to about 12-14mmHg” Betaxolol is DOC because it also increases optic nerve blood flow Drugs with neuroprotective effect like Brimonidine may be preferred PG analogues e.g. latanoprost have greater ocular hypotensive effect in eyes with normal IOP
Treatment
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2.Trabeculectomy: When there is progressive field loss occurs despite IOP in lower teens
3.Systemic calcium channel blockers :(e.g.nifedipine) in patients with confirmed peripheral vasospasm
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REFERNCE - Comprehensive OPTHALMOLOGY 6th Edition by A.K.KHURANA
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THANK YOU!!!!