Preperimetric glaucoma: conversion to primary open-angle glaucoma in a 10-year follow-up.

Abstract

BACKGROUND/AIMS To investigate the clinical course of preperimetric open-angle glaucoma (PPG) over follow-up period exceeding 10 years and to identify factors associated with conversion to primary open-angle glaucoma (POAG). METHODS A total of 124 eyes from 124 PPG patients, followed for more than 10 years, were included. Progression was defined as either structural or functional deterioration. Cox proportional hazard modelling was employed to identify factors for progression. Kaplan-Meier survival analysis was used to compare cumulative progression probability in PPG patients with or without optic disc haemorrhage (DH). RESULTS Among the PPG subjects included, 44 eyes (35.5%) converted to POAG, with a mean deviation change of -0.39±0.64 dB/year over a mean follow-up of 12.2±4.2 years. The mean time to conversion was 5.3±2.2 years. Within the conversion group, 30 eyes (68.2%) exhibited functional progression, 23 eyes (52.3%) showed structural progression and nine eyes (20.5%) demonstrated both. Factors significantly associated with glaucoma progression were migraine/headache (HR=2.19, p=0.012), reduction of intraocular pressure (IOP; HR=0.75, p=0.009), and disc haemorrhage (DH; HR=3.78, p<0.001). Notably, patients with DH exhibited higher cumulative probability of progression compared with those without DH (p=0.017). CONCLUSIONS This study of PPG with more than 10 years of follow-up demonstrates a substantial proportion (35.5%) converting to POAG, highlighting the need for long-term monitoring in these patients. PPG with insufficient IOP reduction and DH was associated with significantly higher cumulative probability of progression, emphasising its prognostic significance in PPG patients.