Journal Reading

Hubungan antara hipertensi sistemik,

tekanan perfusi, dan glaukoma : studi
komparativ pada populasi India dewasa
Oleh : Amelinda Mannuela / 11 2016 121
Pembimbing : dr. Vanessa Maximiliane Tina, Sp. M
 Pendahuluan
• glaukoma →progresif neuropati kronik (┼ ganglion sel retina& peyempitan lapang pandang)
• risk : TIO↑,HT, aterosklerosis, vasospasm, dll→ OAG↑
• hipotesis vaskular : TD↓→MOPP↓→perfusi ONH↓→cuooing glaucomatous & lapang pandang↓
• hipertnesi sistemik→rusak pemb. darah kecil optik disc & risk glaukoma↑
Material & Metode
• Departemen Ophtalmologi. Tertiary health care center. South India. August 2010 - March 2012
• Studi observasi cross-sectional: w/ HT - w/o HT (>40 y.o)
• w/ HT 108 subjek (≥140 / ≥90 mmHg) → ukur TD 1x →lengan kanan, duduk, sphygmomanometer merkuri
(brp thn? obat? DM?) →eksklusi HT e.c penyebab sekunder
• w/o HT (kontrol)→100 age&sex matched subject

• semua subjek→TIO nonkontak tonometer&funduskopi dilatasi→o/ 2 observer.

• MAP=dias+1/3(sis+dias) MOPP=2/3xMAP-TIO
• TIO>21mmHg / C:D≥0.5 / asimetris >0.2 →humphrey central visual field, ultrasonic pachymetry gonioscopy,
opticdisc photography, optical coherence tomography-fast retinal nerve fiber layer, ONH protocols of stratus
OCT

• diag POAG→ glaucomatous cupping; field defect; thinned RNFL, neuroretinal rim on OCT; open angle on
gonioskopi w/ or w/o TIO↑
• suspek POAG→suspicious optic disc; N TIO, RTFL thickness, visual field
Analisis Statistik
• Continuous data→mean → t-test or Mann–Whitney test.
• compare the categorical variables→Chi-square or Fischer’s exact test
• IOP-BP →linear regression.
• IOP-BP and MOPP-glaucoma status→Pearson’s correlation coefficients
• covariates-risk of glaucoma / glaucoma suspect→Univariate and multivariate multinomial
regression
Hasil
pengobatan HT→1½x susp glaukoma + 2x POAG
MOPP↑ 1 mmHG→POAG↓31% & susp glaukoma↓12%

HT→TIO 10-24mmHg = 15.37mmHg

w/o HT→9-23mmHg = 13.41mmHg
→unpaired t-test→significant

MOPP→HT>w/o HT
sis↑ 10mmHg→TIO ↑0.55mmHg
dias↑ 10mmHg→TIO↑0.96mmHg
no difference in galucoma status w/ or w/o HT
Diskusi
• HT sistemik ≠ risk↑ glaucoma / glaucoma suspect
• anti-HT →2-3x↑ glaucoma / glaucoma suspect. Bedtime dosing
→drop in nocturnal BP→↓ONH perfusion.
• TIO HT>normotensi. TIO↑+HT→↑risk glaucomatous optic nerve
damage
• MOPP→↓glaucoma (risk reduction POAG>glaucoma suspect)
• 24-h MOPP fluctuation→risk factor glaucoma severity NTG.
Kesimpulan
• MOPP → pathogenesis of glaucoma on antihypertensive medications.
• Hindari antihipertensi malam hari pada subjek dengan suspek
glaukoma / terbukti OAG.
THANK YOU ♥