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R Susanna, FA Medeiros, A Pinheiro, FC Moura, BC Leal; Intraocular Pressure Fluctuations in Medical versus Surgically Treated Glaucomatous Patients . Invest. Ophthalmol. Vis. Sci. 2002;43(13):297.
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Purpose: Previous studies have suggested that the fluctuations of the intraocular pressure (IOP) are significant risk factors for glaucoma progression and as such may need to be treated specifically. It is important to ascertain whether the treatment provided is adequately reducing mean IOP, peak IOP and fluctuations in a given patient. The purpose of this study was to compare the IOP fluctuations in the daytime tension curves of glaucoma patients under ocular hypotensive therapy with those of patients previously submitted to trabeculectomy. We also evaluated the IOP peaks and fluctuations for the same patients in response to the water-drinking test (WDT). Methods:The study included 30 primary open-angle glaucoma (POAG) patients using ocular hypotensive medications and with no history of previous intraocular surgery (medical group), and 30 POAG patients previously submitted to one or more trabeculectomies though taking no medication at the time of the study (surgical group). All patients were submitted to a diurnal tension curve - DTC (8:30 - 17:00/3-hour intervals) followed by the WDT. To be eligible, the mean IOP of the DTC had to be less than or equal to 15mmHg. The WDT was carried out as follows:the patient was required to drink 1 liter of tap water in 5 minutes. The IOP was measured 3 times at 15-minute intervals and the maximum value of the 3 measurements was considered as the maximum IOP during the WDT. The IOP fluctuation during the WDT was calculated as the maximum IOP minus the baseline IOP (IOP measured just before the test). The patients were matched by mean IOP of the DTC and by age. An analysis of covariance (ANCOVA) was performed using IOP fluctuation in the WDT as response variable, treatment group as factor and baseline IOP as covariate. Results:The IOP fluctuation during the DTC was significantly greater in the medical group than in the surgical group [3.2 ± 1.5 (SD) vs. 2.2 ± 1.7mmHg, p=0.027, Student´s t test]. From an overall baseline IOP of 10.6mmHg, the mean ± SEM of the IOP fluctuation during the WDT was 1.4 ± 0.4mmHg in the surgical group and 3.7 ± 0.4mmHg in the medical group (p<0.0001, ANCOVA). The mean percentile change in IOP following the WDT was 13% in the surgical group and 40% in the medical group. Conclusion:Patients submitted to trabeculectomy have less IOP fluctuations during the diurnal tension curve and following a water-drinking test. This effect could represent an additional benefit of surgery in controlling the intraocular pressure of glaucomatous patients.
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