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Editors Selection IGR 14-2

Intraocular Pressure: Posture-induced IOP changes after trabeculectomy

Comment by Fabian Lerner on:

49023 Effects of trabeculectomy on posture-induced intraocular pressure changes over time, Sawada A; Yamamoto T, Graefe's Archive for Clinical and Experimental Ophthalmology, 2012; 250: 1361-1366

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Sawada and Yamamoto prospectively studied the IOP changes after trabeculectomy with MMC in two different positions: seated and after five minutes in lateral decubitus (over the non-operated fellow side) in a group of patients with open-angle glaucoma. Twenty-nine patients completed the 12-months follow up, and 14 patients were categorized as having normal-tension glaucoma. The IOP was measured with an ICare rebound tonometer, before, and one, three and 12 months after the operation. IOP is reported to be reduced in the 29 eyes in the three time points in the two positions measured. The operation reduced the posture induced changes in the IOP observed pre-operatively. The standard deviation reported is rather high at all time points. More patients may be necessary. It is unclear how the addition of ocular hypotensive therapy in some patients may have influenced the results.

The reduction of IOP fluctuation with postural changes was previously reported.¹ These authors used the pneumatonometer to address postural changes, while the present investigation was done with the ICare rebound tonometer.

Also, IOP was measured in the seated and supine positions. In the present report, IOP is measured in the lateral decubitus. Although several papers have shown that IOP increases when changing from the seated to the supine position, there is little data on what happens in the lateral decubitus position. In fact, this may be a common sleeping position in many people, so having IOP data on this position may be useful. However, it is unclear if lying five minutes in the lateral decubitus position is enough to present conclusions about what happens in that position. More patients are needed in order to conclude that trabeculectomy reduces the fluctuation changes from the seated to the lateral decubitus position. More information is also needed on the IOP when lying for more than five minutes in the lateral decubitus position.

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