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Progression of Normal-Tension Glaucoma After Ventriculoperitoneal Shunt to Decrease Cerebrospinal Fluid Pressure

Purpose:To report a case of worsening normal-tension glaucoma immediately following ventriculoperitoneal (VP) shunt placement to lower cerebrospinal fluid pressure (CSFP). Methods:The clinical records of the patient were reviewed retrospectively. Observations were made and collated as the case progressed. Results:A 93-year-old white woman previously diagnosed with normal-tension glaucoma underwent placement of a VP shunt with a Codman-Hakim programmable valve for normal pressure hydrocephalus. Shortly after the procedure, progressive visual field loss was noted in both eyes and new optic disc hemorrhages were seen in the patient’s right eye. The hemorrhages resolved, but the patient had recurrent complaints of poor gait, memory, and mentation. The CSFP was lowered by reprogramming the Codman-Hakim valve. The patient’s visual fields again worsened in both eyes and a new disc hemorrhage was seen in the right eye. A year later, a new disc hemorrhage was seen in the patient’s left eye. The CSFP was raised by reprogramming the VP shunt. Before the placement of the VP shunt, no optic disc hemorrhages had been observed. Conclusion:This case suggests that relatively low CSFP is a contributor to worsening normal-tension glaucoma, probably by increasing translaminar pressure gradient of the optic nerve.