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M. N. Moraes, S. Cronemberger, P. C. Lana, I. D. Castro, N. Calixto; Efficacy of One Drop of 2% Pilocarpine on the Control of the Peak of the Intraocular Pressure at 6 A.m. in Glaucoma. Invest. Ophthalmol. Vis. Sci. 2010;51(13):589.
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To assess the efficacy of one drop of 2% Pilocarpine (2% Pi) at night on the control of the intraocular pressure (IOP) peak at 6 a.m. during the daily curve of intraocular pressure (DCPo) of primary open-angle glaucoma patients.
Using the DCPo, we made a comparison between the IOP peak at 6:00 a.m. in bed and darkness without medication and under 2% Pi in 51 eyes (30 patients). Each DCPo consisted of 5 IOP measurements taken at 9:00 a.m., 12:00 p.m., 6:00 and 10:00 p.m. (Goldmann applanation tonometer) and in the morning of the following day at 06:00 a.m. (Perkins tonometer) in a supine in bed and in darkness before the patient had stood up. The inclusion criteria was the presence of an IOP peak (ΔIOP≥6 mmHg) at 6:00 a.m. in bed and darkness without medication. We compared the mean IOP (Pm) and the standard deviation (SD) of the two DCPos. Only patients using one drop of 2% Pi at night (10:00 p.m.) for at least 6 months were included. The patients using 2% Pi more than once a day or associated with any other antiglaucomatous drug were excluded. The DCPo without medication was performed in patients who had 19≤IOP≤25 mmHg in isolated tonometry and/or vertical optic disc excavation≥0.7 and/or an asymmetry on the optic disc excavation >0.2. The Pm and SD of the DCPos without medication and under 2% Pi were compared using the paired t test. The Pm and SD values were compared with the superior normal limits of the mean Pm and mean SD (+ 2 SD) of the DCPo from normal patients of the same age group from our Service.
Fifty-one eyes of 30 patients (23 women and 7 men) were included. The patients’ average age was 59.13 years old. Nine eyes were excluded for not presenting an IOP peak at 6:00 a.m. The IOP peak at 6:00 a.m. was reverted in 37 eyes (72.5%). From the 51 eyes before the use of 2% Pi, 18 (35.3%) presented abnormal Pm and 33 (64.7%) normal Pm; 49 eyes (96%) presented abnormal SD and 2 (4%) presented normal SD. After the use of one drop of 2% Pi, 47 eyes (92.2%) presented normal Pm and 4 (7.8%), abnormal Pm; 14 eyes (27.4%) presented normal SD and 37 (72.5%), abnormal SD. There was a statistically significant difference between the IOP peak and Pm without medication and under 2% Pi (P = 0.004 and P= 0.005, respectively). No statistically significant difference was found between the SD without medication and under 2% Pi (P=0.375).
We recommend the use of one drop of 2% Pi at night for glaucoma patients who present an IOP peak at 6:00 a.m. in bed and darkness.
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