Duration 5min, Q&A 3min
Intraocular Pressure Fluctuation in Treated Glaucoma Patients: 24 hours Versus 48 Hours
To evaluate the 24-hours and 48-hours intraocular pressure (IOP) fluctuation in treated glaucoma patients and its impact to our clinical management.
All treated glaucoma patients from January 2011 to April 2013; who had progression despite of controlled IOP during outpatient clinic follow up under single consultant been included in the study.
All subjects were admitted one day earlier in the evening and underwent Goldmann applanation tonometry the next morning at 9 a.m., 12 p.m., 15 p.m., 18 p.m., 21 p.m. and 24 a.m. for 2 consecutive days. 127 subjects (254 eyes) with glaucoma were included. Patients with one blind eye or one normal eye were excluded. Mean, peak, trough and fluctuation IOP of 24-hours and 48-hours in right and left eye were compared.
Results and Conclusion
Mean age of the patients was 62.7±12.8 years old. NTG was 66 patients, POAG was 52 patients, PACG was 6 patients and Secondary glaucoma was 5 patients. Mean outpatient clinic IOP before subjected to admission was 13.89±2.77 mmHg. Mean number of anti-glaucoma used was 2.5±0.8 bottles.
There was statistically significant difference between 24-hours and 48-hours IOP in both right and left eye in mean, peak, trough and fluctuation IOP. (all p<0.01). Right eye: Mean IOP 24-hours 14.21±2.47 and 48-hours 13.89±2.41 mmHg, mean peak 24-hours 16.44±3.21 and 48-hours 17.07±3.46 mmHg, mean trough 24-hours 12.05±2.16 and 48-hours 11.09±2.17 mmHg, mean fluctuation 24-hours 4.39±2.36 and 48-hours 5.98±2.52 mmHg. Left eye: Mean IOP 24-hours 14.11±2.64 and 48-hours 13.88±2.52 mmHg, mean peak 24-hours 16.34±3.39 and 48-hours 17.01±3.48 mmHg, mean trough 24-hours 12.13±2.39 and 48-hours 11.14±2.12 mmHg, mean fluctuation 24-hours 4.20±2.24 and 48-hours 5.87±2.53 mmHg. There was no statistically significant difference in mean, peak, trough and fluctuation IOP between right and left eye in neither 24-hours nor 48-hours. Agreement between first and second day of mean IOP at all-time point was only fair. (Intraclass correlation coefficient, ICC 0.57 to 0.73). 79 eyes (50.3%) out of 157 eyes that had fluctuation IOP <5 mmHg in 24-hours, found to have fluctuation IOP ≧ 5 mmHg when measured for 48-hours. Out of these 79 eyes, 36 eyes (45.6%) had been subjected to either surgical intervention or alteration of medication.
Conclusion: This observation limits the clinical value of one day circadian IOP monitoring in clinical practice. 48-hours IOP measurement could identify the IOP variability, fluctuation and spikes better than 24-hours IOP measurement in a patient. This may affect the decision making for surgery or medication.
[ Keyword ]
glaucoma, intraocular pressure, fluctuation, circadian, 24 hours, 48 hours
[ Conflict of Interest ]