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  1. Ramli N, Nurull BS, Hairi NN, Mimiwati Z
    Prev Med, 2013;57 Suppl:S47-9.
    PMID: 23352960 DOI: 10.1016/j.ypmed.2013.01.007
    In the absence of raised intraocular pressure (IOP), haemodynamic parameters have been implicated in the development of normal tension glaucoma (NTG). The purpose of this study is to compare 24-hour IOP and haemodynamic parameters in NTG patients and non-glaucoma patients.
    Matched MeSH terms: Low Tension Glaucoma/physiopathology
  2. Raman P, Suliman NB, Zahari M, Kook M, Ramli N
    Eye (Lond), 2018 07;32(7):1183-1189.
    PMID: 29491486 DOI: 10.1038/s41433-018-0057-8
    OBJECTIVE: To assess the relationship between baseline intraocular pressure (IOP), blood pressure (BP) and ocular perfusion pressure (OPP), and the 5-year visual field progression in normal-tension glaucoma (NTG) patients.

    DESIGN: Prospective, longitudinal study.

    METHODS: Sixty-five NTG patients who were followed up for 5 years are included in this study. All the enrolled patients underwent baseline 24-h IOP and BP monitoring via 2-hourly measurements in their habitual position and were followed up for over 5 years with reliable VF tests. Modified Anderson criteria were used to assess VF progression. Univariable and multivariable analyses using Cox's proportional hazards model were used to identify the systemic and clinical risk factors that predict progression. Kaplan-Meier survival analyses were used to compare the time elapsed to confirmed VF progression in the presence or absence of each potential risk factor.

    RESULTS: At 5-year follow-up, 35.4% of the enrolled patients demonstrated visual field progression. There were statistically significant differences in the mean diastolic blood pressure (p low nocturnal DOPP at baseline as a significant predictive risk factor for glaucomatous visual field progression at 5 years. An mmHg decrease in nocturnal DOPP increases the hazard of progression by 1.4 times. Patients with DOPP  43.7 mmHg (log rank = 0.018).

    CONCLUSION: Diastolic parameters of BP and OPP were significantly lower in the NTG patients who progressed after 5 years. Low nocturnal DOPP is an independent predictor of glaucomatous visual field progression in NTG patients.

    Matched MeSH terms: Low Tension Glaucoma/physiopathology*
  3. Raman P, Suliman NB, Zahari M, Mohamad NF, Kook MS, Ramli N
    J Glaucoma, 2019 11;28(11):952-957.
    PMID: 31688446 DOI: 10.1097/IJG.0000000000001359
    PRECIS: This 5-year follow-up study on normal-tension glaucoma (NTG) patients demonstrated that those with baseline central visual field (VF) defect progress at a more increased rate compared with those with peripheral field defect.

    PURPOSE: The purpose of this study was to investigate the clinical characteristics, including 24-hour ocular perfusion pressure and risk of progression in patients with baseline central VF defect, as compared with those with peripheral VF defect in NTG.

    DESIGN: This was a prospective, longitudinal study.

    METHODS: A total of 65 NTG patients who completed 5 years of follow-up were included in this study. All the enrolled patients underwent baseline 24-hour intraocular pressure and blood pressure monitoring via 2-hourly measurements in their habitual position and had ≥5 reliable VF tests during the 5-year follow-up. Patients were assigned to two groups on the basis of VF defect locations at baseline, the central 10 degrees, and the peripheral 10- to 24-degree area. Modified Anderson criteria were used to assess global VF progression over 5 years. Kaplan-Meier analyses were used to compare the elapsed time of confirmed VF progression in the two groups. Hazard ratios for the association between clinical risk factors and VF progression were obtained by using Cox proportional hazards models.

    RESULTS: There were no significant differences between the patients with baseline central and peripheral VF defects in terms of demography, clinical, ocular and systemic hemodynamic factors. Eyes with baseline defects involving the central fields progressed faster (difference: βcentral=-0.78 dB/y, 95% confidence interval=-0.22 to -1.33, P=0.007) and have 3.56 times higher hazard of progressing (95% confidence interval=1.17-10.82, P=0.025) than those with only peripheral defects.

    CONCLUSION: NTG patients with baseline central VF involvement are at increased risk of progression compared with those with peripheral VF defect.

    Matched MeSH terms: Low Tension Glaucoma/physiopathology
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