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Baskaran Mani, Tin Aung, National University of Singapore; 24-hour intraocular pressure (IOP) fluctuation profile before and after laser peripheral iridotomy in newly diagnosed subjects with primary angle closure. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5637.
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To evaluate the 24-hour circadian intraocular pressure (IOP) fluctuation profile before and after laser peripheral iridotomy (LPI) in newly diagnosed subjects with primary angle closure (PAC) using a contact lens based IOP sensor.
Seven newly diagnosed primary angle closure subjects from a glaucoma clinic underwent diurnal IOP profiling with Goldmann applanation tonometry (GAT at 8 am, 10 am, 12 noon and 2 pm), gonioscopy and 24-hour IOP profiling using a contact lens based IOP sensor (Sensimed TriggerfishTM, Lausanne, Switzerland) before and after LPI. Mean GAT IOP and GAT IOP fluctuation (Maximum IOP - Minimum IOP) were compared using Wilcoxon rank sum test. Serial measurement analysis of the time-weighted average of 24-hour IOP fluctuation (in arbitrary units) and comparison between specific times of the day were performed using non-parametric methods.
The mean age of study participants was 65 (±5.6) years and most of the subjects were of Chinese origin (6/7) and female (5/7). Mean baseline GAT IOP was 23.29 (±0.49) mm Hg. The angle remained closed in 3/7 (42.9%) subjects even after LPI. Comparing pre and post LPI, there was no difference in mean diurnal GAT IOP [19.66 (±2.09) vs 16.7 (±3.57) mm Hg, p=0.25], or mean GAT IOP fluctuation [6.86 (±2.67) vs 5.29 (±1.89), p=0.58]. For both pre and post LPI 24-hour IOP profiling with the IOP sensor, we found nocturnal and morning IOP peaks compared to evening measurements (Figure 1, p<0.0001, Kruskal Wallis test). Using serial measurement analysis, there was no significant change in median IOP fluctuations after LPI overall (p=0.25) or during specific times of the day (p=0.48); however, morning IOP profile showed a trend of less IOP fluctuation after LPI (Figure 1).
Nocturnal and morning peaks in IOP were found in newly diagnosed PAC subjects. Morning IOP peaks were lower after LPI.
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