Normotensive Glaucoma and Risk Factors in Normotensive Eyes With Pseudoexfoliation Syndrome

Purpose: To evaluate the prevalence of normotensive glaucoma (NTG) in patients with pseudoexfoliation (PEX) syndrome. Methods: In this prospective study, 178 eyes of 178 patients with PEX syndrome who had no previous history of antiglaucomatous treatment were evaluated in terms of NTG prevalence. NTG diagnosis was based on the presence of glaucomatous optic nerve head damage with glaucomatous visual field defects, open angles, and intraocular pressure (IOP) levels less than 22 mm Hg. Two groups of normotensive pseudoexfoliative eyes with or without glaucomatous findings were compared in terms of age, sex, the presence of systemic diseases and mean IOP, maximum IOP. and IOP fluctuation levels. Results: The IOP levels were below 22 mm Hg in 109 of the 178 eyes, and 24% (n = 27) of those eyes were diagnosed as NTG. There were no significant differences between the eyes with or without glaucoma in terms of age, sex, and the presence of systemic diseases (P > 0.05). The mean IOP. maximum IOP, and IOP fluctuation levels were significantly higher in eyes with NTG when compared with eyes without glaucoma (P < 0.05). Univariate analysis revealed that significant risk factors associated with NTG in patients with PEX syndrome were higher mean IOP (>= 14 mm Hg), higher maximum IOP (>= 18 mm Hg), and greater IOP fluctuation (>= 4 mm Hg). In multivariate analysis, these factors were higher maximum IOP and greater IOP fluctuation range (P = 0.003, P < 0.001, respectively). Conclusions: There are glaucomatous findings in a significant proportion of normotensive patients with PEX syndrome. The high maximum IOP levels and greater IOP fluctuation range may be contributory factors in the pathogenesis of NTG in patients with PEX syndrome.