Aims: The objective of this study was to investigate the association between blood pressure (BP) and visual field defect progression in normal-tension glaucoma (NTG). Methods: The subjects were 35 consecutive patients with NTG who were admitted to Keio University Hospital for 24-hour intraocular pressure evaluation; all subjects underwent 6 or more visual field tests in either eye and were followed up for more than 5 years. Systolic and diastolic BPs were measured at 9.00 h. Subjects with negative regression lines and p values of less than 0.05 were classified as progressive; all others were defined as stable. Systolic BP, diastolic BP, and ocular perfusion pressure were compared between the 2 groups. Results: Twelve subjects showed progression in glaucomatous visual field defects (age 55.1 ± 15.1 years). Twenty-three subjects showed no progression (age 57.2 ± 10.9 years). Diastolic BP (stable group: 77.0 ± 12.1 mm Hg; progressive group: 67.7 ± 9.7 mm Hg; p = 0.03) was significantly lower in the progressive group than in the stable group. Multivariable analysis revealed that low diastolic BP is a significant risk factor for progression (OR 0.90; 95% CI 0.82–0.99). Conclusions: Low diastolic BP was associated with glaucomatous visual field progression in subjects with NTG.

To report a case of pupillary block glaucoma after implantation of iris-fixated phakic intraocular lens (IF pIOL). A 43-year-old man was referred for pupillary block one day after implantation of IF pIOL. Slit-lamp examination revealed extremely shallow anterior chamber, closure of peripheral laser iridotomy and contact of iris on the peripheral of the optics of IF pIOL. The intraocular pressure (IOP) was 62 mm Hg. The iris moved forward in contact with the IF pIOL and the lens remained in the physiologic position, which made the distance between the lens and the iris wide. He underwent an uneventful peripheral surgical iridectomy and the IOP decreased to 6 mm Hg. Acute pupillary block glaucoma can occur after IF pIOL implantation due to the occlusion of aqueous flow between the IF pIOL and the iris if the peripheral iridotomy closes.