Introduction: Because of a theoretical risk that ventriculoperitoneal shunts (VPS) could worsen glaucoma by increasing the translaminar gradient. The purpose of this study was to prospectively monitor hydrocephalus (NPH) patients with VPS and evaluate for the development and progression of glaucoma.
Methods: Patients with NPH and VPS were prospectively and consecutively enrolled. Patients had baseline and serial eye exams, OCT of the optic nerve, and visual fields. Patients diagnosed with possible glaucoma were independently reviewed by a neuro-ophthalmologist and glaucoma specialist.
Results: 94 patients with NPH and VPS implantation were enrolled. 74 patients had baseline and post-operative testing. 4 (5.4%) patients developed primary open angle glaucoma (POAG) after VPS, 2 (2.7%) patients with POAG prior to VPS had disease progression and 4 (5.4%) patients with POAG prior to VPS had no disease progression. 87% (13/15) of cases had agreement between specialists. The remaining 13% of cases were reviewed together for consensus. Preliminary analysis suggest glaucoma incidence = 2.0 events/4.5 years, compared to 0.46 events/4.5 years in control group.
Conclusion : Preliminary analysis suggests possible increased risk of glaucoma (normal tension) after VPS including primary development and progression of pre-existing glaucoma. Low absolute incidence/events requires large case cohort and multi-factorial propensity matching
.jpg)
