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Coincidence of normal tension glaucoma, progressive sensorineural hearing loss, and elevated antiphosphatidylserine antibodies

¹ Department of Ophthalmology, University Hospital Essen, Essen, Germany
² Department of Immunology, University Hospital Essen, Essen, Germany
³ Department of Otorhinolaryngology, University Hospital Essen, Essen, Germany

Correspondence to:
Correspondence to:
Stephan Kremmer MD
Department of Ophthalmology, University Hospital Essen, Hufelandstrasse 55, 45122 Essen, Germany; stephan.kremmer{at}uni-essen.de

ABSTRACT
Background: Recently, in patients with normal tension glaucoma (NTG) elevated levels of antiphosphatidylserine antibodies (APSA), a subgroup of antiphospholipid antibodies (APLA) were found. Progressive sensorineural hearing loss (PSHL) is associated with autoimmune diseases and also the presence of APLA.

Methods: To investigate a possible association between NTG and PSHL, 34 patients (age range 31–81 years) with NTG were evaluated for evidence of audiovestibular disorders. Besides ophthalmological standard examinations (slit lamp, IOP, funduscopy, perimetry) scanning laser tomography and polarimetry were performed. From all patients’ audiograms, stapedial thresholds and otoacoustic emissions were obtained. The serological testing of patients and controls (40 healthy blood donors older than 50 years) concerned IgG and IgM levels of antibodies against phosphatidylserine (APSA) and ß2 glycoprotein.

Results: 23 of 34 NTG patients had hearing loss (PSHL n = 11; presbyacusis n = 12). The NTG patients had significantly higher APSA levels than controls. Elevated APSA concentrations were significantly more frequent in patients with NTG and hearing loss compared with NTG patients with normacusis.

Conclusions: These findings show that NTG and hearing loss have a high coincidence. The elevated APSA levels may indicate an association with similar systemic autoimmune processes.

Abbreviations: APLA, antiphospholipid antibodies; APSA, antiphosphatidylserine antibodies; IOP, intraocular pressure; NTG, normal tension glaucoma; POAG, primary open angle glaucoma; PSHL, progressive sensorineural hearing loss

Keywords: normal tension glaucoma; progressive sensorineural hearing loss; antiphospholipid syndrome; antiphosphatidylserine antibodies