Abstract: Objective To evaluate the risk factors of the glaucomatous optic neuropathy progression in patients with primary open angle glaucoma (POAG). Design Retrospective case series. Participants The study included 197 eyes of 115 patients with POAG. All the patients were followed up for at least 3 years in Beijing Tongren Eye Center. Methods Mean follow-up time was 56.64±14.84 months. All the patients had complete fundus photographs and intraocular pressure(IOP) recording. The glaucoma specialists, masked to chronological sequence, examined pairs of optic disc photographs to determine whether the appearance of the optic disc had changed. Progression of glaucoma was defined as loss of neuroretinal rim as detected by disc photographs. Long-term IOP fluctuation was defined as the standard deviation of IOP. Main Outcome Measures Multivariate Logistic regression analysis of the factors which may lead to the progression of the glaucomatous optic neuropathy. Results Progression of glaucomatous optic nerve changes was detected in 98 eyes (49.75%) and 99(50.25%) eyes were stable.  There were statistically significant differences between progressive and non-progressive eyes for optic disc hemorrhage (P=0.02) and enlargement of beta zone parapapillary atrophy (P=0.000). In univariate logistic analysis, there were statistically significant differences between progressive and non-progressive eyes for peak IOP (P=0.001), IOP fluctuation (P=0.000) and duration of follow up (P=0.041). In multivariate logistic regression analysis, there were statistically significant differences between progressive and non-progressive eyes for IOP fluctuation (P=0.000, OR=2.522) and enlargement of beta zone parapapillary atrophy (P=0.000, OR=25.655). The IOP fluctuation was larger in patients with glaucomatous optic neuropathy progression (2.87±1.29, 0.89-7.21) than the patients who were stable (2.11±0.94, 0.25-4.97). There were 75 eyes with enlargement of beta zone parapapillary atrophy in the 98 eyes with glaucomatous optic neuropathy progression (76.53%). Conclusions  Large intraocular pressure fluctuation and enlargement of beta zone parapapillary atrophy are predictive factors for progression of optic neuropathy in POAG. (Ophthalmol CHN, 2012, 21: 39-42)

Key words: primary open angle glaucoma, intraocular pressure fluctuation, parapapillary atrophy