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Editors Selection IGR 14-3
Clinical Examination Methods: 24-h IOP Variations under Treatment
Comment by Tomas Grippo & Facundo Sanchez on:
73171 Twenty-Four-Hour Variation of Intraocular Pressure in Primary Open-Angle Glaucoma Treated with Triple Eye Drops, Itoh Y; Nakamoto K; Horiguchi H et al., Journal of Ophthalmology, 2017; 2017: 4398494
Yoshinori et al. performed a prospective study to evaluate the 24-hour intraocular pressure (IOP) variation in 74 eyes of 74 patients with moderate primary open-angle glaucoma treated with triple eye drops (beta-blockers, prostaglandin analogs and carbonic anhydrase inhibitors). Measurements were perfomed in the sitting position at all time points (10:00, 13:00, 16:00, 19:00, 22:00, 1:00, 3:00, and 7:00) using Goldmann applanation tonometry. Statistical analysis included subdividing the patients into diurnal and nocturnal based on IOP peak-time during the 24-hour period. They found that peak IOP occurred at 1:00, and was significantly different than the trough IOP at 7:00 (p<0.05). Sixty eyes (62.5%) did not have peak IOP during office hours. Patients were also subdivided into high-myopic and low/non-myopic eyes based on spherical equivalent. Low/non-myopic eyes showed a significant IOP rise during the night (especially in those with a spherical equivalent of -2D or less). However, the origin of the refractive error (i.e. lenticular vs axial) was not described, which makes interpretation of this finding difficult.
Additional limitations of this study are related to the considerable variation in glaucoma eye drops used, which may affect the 24-hour IOP patterns. As well, the IOP measurement technique involved waking patients and placing them in a sitting position, which does not match the normal physiologic position during sleep, potentially affecting IOP readings.
Nevertheless, this study contributes to our understanding of the impact of triple hypotensive therapy on the 24-hour IOP pattern. It demonstrated that even under triple therapy, most patients will have their peak IOP outside office hours (night time), similarly to what Liu et al. observed in untreated glaucoma eyes (in the habitual positions).1 As well, some variables, such as refractive error, may help identify patients that are more likely to have nocturnal IOP peaks.
References
- Liu JH, Zhang X, Kripke DF, Weinreb RN. Twenty-four-hour intraocular pressure pattern associated with early glaucomatous changes. Invest Ophthalmol Vis Sci. 2003 Apr;44(4):1586-90.
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