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Cord R. Huchzermeyer, Robert Laemmer, Folkert Horn, Christian Y. Mardin, Anselm G. Junemann; Short-term and Long-term Fluctuation of Intraocular Pressure in Patients with Pseudoexfoliation Syndrome from the Erlangen Glaucoma Registry. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5055.
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To analyze short-term and long-term fluctuation of patients with pseudoexfoliation (PEX) syndrome from the Erlangen Glaucoma Registry (EGR) compared to data of patients with primary open angle glaucoma (pOAG) from the literature.
For the EGR (ClinicalTrials.gov number NCT00494923), standardized glaucoma examinations were performed anually including slit-lamp examination, automated perimetry, dilated fundus examination, and standardized photograph of the optic nerve head (ONH). IOP was measured 5x daily by an experienced resident using Goldmann applanation tonometry.Patients were treated medically or surgically according to the current clinical standards.From this data, patients with PEX were identified and classified as having PEX syndrome (normal ONH, normal visual field, IOP normal or elevated), preperimetric PEX glaucoma (cupping of ONH, normal visual field), or perimetric PEX glaucoma (ONH cupping and visual field defects).Short-term fluctuation was defined as standard deviation or range of IOP during the 24h IOP profile. Values from different examinations were averaged for each patient. Long-term fluctuation was defined as standard deviation (SD) of IOP at noon from examination to examination, regardless of progression or changes in treatment regimen.
From the database, 39 subjects with PEX with a mean age of 59±8 years were identified. The mean follow-up on these patients was 8±6 years. Nine had PEX syndrome (PSX), 11 had preperimetric glaucoma (prePXG), and 19 had perimetric glaucoma (PXG). Penetrating surgery had been performed in 14 patients either prior to inclusion in the EGR or during follow-up. On average, patients were treated with 1.1±0.8 eyedrops.The overall mean IOP was 17.0±3.1 mmHg, the patients' maximum IOP was 26.0±7.1 mmHg. Mean IOP was signficantly higher in PSX vs. prePXG (18.7±2.5 vs 16.5±1.9mmHg, p<0.05) but not vs. PXG (16.5±3.7mmHg). The range of short-term fluctuation of IOP (all patients) was 7.2±3.3 mmHg, the SD 2.8±1.2 mmHg (no significant difference between groups). The mean long-term fluctuation was 3.8±2.9 mmHg (SD). Again, there were no signficant differences between groups.
In this study, the range of short-term IOP fluctuation was not higher in patients with PEX compared to published data from patients with pOAG. This may be explained by the young age of our patients and by the attempted tight IOP control.Long-term fluctuation of IOP was comparable to data from the AGIS study and was higher compared to data from the EMGT study. In the EMGT, only untreated glaucoma patients were eligible. Changes in treatment regimen may be responsible for the higher long-term fluctuation in our study.
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