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Editors Selection IGR 18-4

Intraocular Pressure: 24-hour IOP and optic disc appearance

Comment by Marcello Nicolela on:

23860 Relationship of the 24-hour pattern of intraocular pressure with optic disc appearance in primary open-angle glaucoma, Deokule SP; Doshi A; Vizzeri G et al., Ophthalmology, 2009; 116: 833-839

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Does the glaucomatous optic disc appearance tell us anything about the underlying pathogenic mechanisms? Previous studies have identified different clinical characteristics associated with various optic disc appearances, suggesting specific risk factor profiles for each group. Deokule et al. (630) performed a cross sectional study to evaluate the 24-hour pattern of IOP in patients with distinct optic disc appearances. Optic discs of glaucoma patients who had undergone 24-hour IOP measurements in a sleep laboratory were classified into one of four groups by two graders: focal, sclerotic, myopic or concentric disc appearances. The two graders were able to classify 75 out of 112 eyes into one of the four groups; agreement between the two graders was excellent (kappa of 0.91). Unfortunately, due to the relative small number of eyes in certain groups, analysis

Particularly patients with concentric optic disc appearance might have a higher IOP during the night

was done comparing nonconcentric (including focal, myopic and sclerotic eyes) and concentric disc appearances. The 24-hour IOP curve was obtained prior to initiation of glaucoma therapy in newly diagnosed patients or after a 4-week wash-out in treated patients; IOP was measured with a pneumotonometer in the supine and seating position during the day and in the supine position only at night. Eyes with a concentric disc appearance (n = 40) had significantly greater mean nocturnal IOP than the nonconcentric group (n = 35), and most IOP peaks occurred during the night in the concentric group, as opposed to during the day in the nonconcetric group. No significant differences in IOP were observed during the day. This study unveils yet another clinical characteristic associated with a specific type of optic disc appearance. The differences between the groups could have been better characterized if a larger sample size would have allowed for analysis of focal, myopic and sclerotic groups independently. The implication of this study is to alert the clinician to the possibility of higher IOP during the night, particularly in patients with concentric optic disc appearance.

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