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S. Cronemberger, A. C. L. Silva, N. Calixto; The Importance of Intraocular Pressure at 6:00 a.m. in Bed and Darkness in Suspects and Glaucomatous Patients. Invest. Ophthalmol. Vis. Sci. 2008;49(13):1051.
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to evaluate the importance of the measure of IOP at 6:00 a.m. in bed and darkness in the DCPo for the diagnosis and the control of POAG.
retrospective analysis of the DCPo of suspects and glaucomatous patients. Suspects were the patients who presented IOP ranging from 19 to 24 mmHg in isolated measure and/or cup/disc ratio (C/D) bigger that 0.5 in one or both eyes and/or asymmetry of C/D bigger that 0.2. In the suspects patients, the DCPo was carried through with diagnostic purpose. In the glaucomatous patients (with pathological C/D and visual field loss), the DCPo was made to assess the effectiveness of the clinical and/or surgical treatment. Each DCPo had five or six measures of IOP made with applanation Goldmann tonometer (9:00 and 11:30 a.m. and 3:00 and/or 6:00 p.m. and 10:00 p.m.) and in the morning of the following day at 6:00 a.m. in bed and darkness with Perkins tonometer. IOP measurements were made by two of the authors (SC and NC). It was only considered the DCPo that presented peak of IOP (difference between the bigger and the lesser value of IOP) equal or superior to 6 mmHg (abnormal IOP variation). DCPo of glaucomatous patients whose glaucoma was not POAG was excluded.
331 DCPo were enclosed (21.2%) totalizing DCPo of 565 eyes, being 206 (62.2%) of suspects (361 eyes) and 125 (37.8%) of POAG (204 eyes). From the 1560 DCPo analyzed, 1229 (78.8%) were excluded by not filling the inclusion criteria. In the suspects patients, 64.3% of the eyes, on average, presented the peak of IOP at 6:00 a.m. in bed. This means that almost 2/3 of the suspects had the diagnosis of glaucoma made by the measure of IOP at 6:00 a.m. in bed. In the glaucomatous patients, 68.6% of the eyes, on average, also presented the peak of IOP at 6:00 a.m. in bed. This also means that more than 2/3 of the patients with POAG presented inadequate control of the IOP disclosed for the measure of at 6:00 o’clock in bed. Moreover, in 5.3% of the suspects, the profile of the DCPo revealed inverted (lesser value of the IOP at 6:00 a.m. in bed), what also occurred in 5.9% of the patients with POAG.
On average, 66.5% of the peaks of IOP in the suspects and glaucomatous patients with inadequate control occurred in the measure of IOP at 6:00 o’clock in bed. Also, at 6:00 a.m. in bed, on average, 5.6% of the eyes of suspects and glaucomatous patients with inadequate control presented the lesser value of the IOP. These findings enhance that, in the doubtful cases, to stamp the diagnosis of glaucoma in suspects and for the adequate evaluation of the clinical and/or surgical treatment of POAG, the measure of the IOP at 6:00 a.m. in bed and darkness is indispensable.
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