Akhunzada Muhammad Aftab, Awais Rauf, Asif, Mustafa Iqbal, Sobia Sabir Ali, Atif Rana.
Normal Tension Glaucoma & Cerebral Ischemia / Brain Atrophy.
Ophthalmol Update Jan ;13(2):104-6.

Purpose: To find incidence of cerebral ischemia and (or) brain atrophy in patients diagnosed as normal tension glaucoma using magnetic resonance imaging. Materials and Methods: Patients diagnosed with Normal Tension Glaucoma were admitted and underwent 2 hourly IOP phasing for 24 hours to exclude unrecognized IOP spikes. Detailed ophthalmological examination including visual acuities, best corrected visual acuity, pupils examination, IOP measurement, gonioscopy, optic disc and fundus examination was carried out on all patients. Humphrey Visual Field analysis and Central Corneal Thickness (CCT) was done and correction factors were applied to all IOP readings. All patients underwent an MRI Brain and Orbits without contrast. T1, T2 and FLAIR images were obtained and reported by a consultant radiologist. Hematological and other radiological investigations were done to exclude other causes of cerebral ischemia. Results: Total number of patients in this study was 19. Most patients included in our study were females(63%). Mean age was 60 years (range 42- 75 years). None of the study patients recorded a corrected IOP reading of more than 21 mmHg on phasing. MRI imaging revealed 15 (79%) patients having cerebral ischemic changes and (or) brain atrophy. In these patients, 10 had cerebral ischemic changes including small lacunar infarcts, while 5 patients were reported as having gross brain atrophy with small vessel ischemic changes in brain. Conclusion: The study suggests a greater incidence of cerebral ischemia and (or) brain atrophy in patients with normaltension glaucoma.

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