Effect of inverted body position on intraocular pressure

We evaluated changes in intraocular pressure in eyes with primary open-angle glaucoma after inversion into a totally dependent position with the head down and compared them with the changes intraocular pressure in healthy nonglaucomatous eyes. Five minutes after inversion, intraocular pressure increased from 16.8 mm Hg +/- 2.8 (sitting) to 32.9 mm Hg +/- 7.9 in normal eyes and from 21.3 mm Hg +/- 2.3 (sitting) to 37.6 mm Hg +/- 5.0 in glaucomatous eyes. Although visual fields were unchanged after inversion, glaucomatous eyes may be particularly susceptible to such changes and unable to withstand the transient but significant increase in intraocular pressure that occurs after assuming an inverted position. We recommend that patients with ocular hypertension or glaucoma refrain from this activity.     

Pulsatile ocular blood flow in primary open-angle glaucoma and ocular hypertension

PURPOSE: To compare pulsatile ocular blood flow measurements in untreated ocular hypertensive (OHT) subjects and primary open-angle glaucoma (POAG) patients. DESIGN: A prospective observational study in an institutional setting. METHODS: A total of 97 subjects were recruited to the study (50 ocular hypertensives, 24 glaucoma patients, and 23 normal subjects). "High-risk" OHT had intraocular pressure (IOP) > 25 mm Hg; "low-risk" OHT had IOP 相似文献   

Episcleral venous pressure in younger and older subjects in the sitting and supine positions

PURPOSE: Intraocular pressure is higher in older than younger subjects during the day and night. We attempted to determine whether episcleral venous pressure could explain the difference in the sitting and supine positions. PARTICIPANTS AND METHODS: We compared episcleral venous pressure, intraocular pressure, and blood pressure in a group of younger subjects aged 18 to 30 years and in a group of older subjects aged 65 years or older. The above measurements were performed in the sitting position and after 15 minutes in the supine position. RESULTS: The main difference between the groups was their systemic conditions. Comparing both groups, episcleral venous pressure and intraocular pressure were not different in the sitting position. However, in the supine position, episcleral venous pressure (9.6 vs. 8.3 mm Hg) (P < 0.01) and intraocular pressure (17.1 vs. 15.6 mm Hg) (P < 0.05) were higher in the older group. Statistically, a within-group analysis showed a significant increase in intraocular pressure in the supine position for both the younger (+ 0.8 mm Hg) (P < 0.001) and older subjects (+ 1.8 mm Hg) (P < 0.02). This was associated with an increased episcleral venous pressure in younger (+ 0.4 mm Hg) (P < 0.001) and older subjects (+1 mm Hg) (P < 0.02). There was no gender difference in intraocular pressure and episcleral venous pressure. No differences were found for intraocular pressure and episcleral venous pressure in subjects having certain systemic conditions. Blood pressure was higher for older subjects (P < 0.001). It decreased in the supine position for both groups (P < 0.001). CONCLUSION: Intraocular pressure and episcleral venous pressure were not different in the younger and older group in the sitting position. They were higher in the supine position for older subjects. There was no gender difference.     

Open-angle glaucoma: variations in the intraocular pressure after visual field examination

PURPOSE: To evaluate intraocular pressure (IOP) variations after automated visual field examination in patients with primary open-angle glaucoma and in healthy subjects. PATIENTS AND METHODS: Intraocular pressure was measured in 49 patients (94 eyes) with primary open-angle glaucoma and in 13 healthy subjects (26 eyes) before and immediately after automated visual field examination. All patients had stable IOP and were using local medication to treat glaucoma. The visual field test was performed with a Humphrey 630 VF analyzer and the Central 30-2 full-threshold program. RESULTS: Mean IOP increased significantly in glaucomatous patients immediately after automated visual field examination (P < 0.01), and returned to pretest values after 1 hour (P = 0.2). Mean IOP variation was 2.38 (range, -6-11) mm Hg. In 42 (44.68%) glaucomatous eyes, IOP increased more than 2 mm Hg, with a mean increase of 5.5 mm Hg. Elderly glaucoma patients showed a significantly higher IOP rise than younger patients. No significant IOP variation was detected in healthy subjects. CONCLUSION: Intraocular pressure varied significantly and tended to increase immediately after automated visual field examination in patients with primary open-angle glaucoma. Age seemed to contribute to these IOP changes, but other factors could be involved.     

Factors associated with long-term progression or stability in primary open-angle glaucoma

PURPOSE: To evaluate long-term risk factors for progression or stability in patients with primary open-angle glaucoma. METHOD: We retrospectively included consecutively reviewed patients who had primary open-angle glaucoma for at least 5 years in this multicenter trial. Historical and clinical factors in these patients were evaluated for their association with stability or progression of the glaucoma. RESULTS: We included 218 patients in this study; of these, 34 progressed over an average length of follow-up of 45.5 +/- 30.0 months, and 184 were stable over an average of 72.8 +/- 18.3 months. The mean intraocular pressure over the follow-up period for the progressed group was 19.5 +/- 3.8 mm Hg and for the stable group 17. 2 +/- 3.1 mm Hg (P =.001). The average standard deviation of individual intraocular pressures was greater in the progressed group (5.1 mm Hg) than the stable group (3.9 mm Hg, P =.012). Baseline characteristics indicating a greater potential to progress were a larger cup-to-disk ratio (P <.001), a greater number of medications (P =.02), older age (P.007), and worse visual acuity (P =.003). However, no difference was observed in pressure levels that prevented progression in these subpopulations compared with the total sample size. CONCLUSIONS: This study suggests that lowering the intraocular pressure is important in the treatment of primary open-angle glaucoma to help prevent long-term progression. Lowering the pressure, however, is not uniformly effective in preventing progression. Additionally, risk factors for progression do not further help identify pressure levels that prevent worsening of glaucoma.     

Postural change of IOP in normal persons and in patients with primary wide open-angle glaucoma and low-tension glaucoma.

The values of intraocular pressure (IOP) measurements by an Alcon pneumatic tonometer and a Goldmann applanation tonometer were found to be close, with a correlation coefficient of 0.92. Measured by the pneumatonograph the IOP after 30 minutes in the supine position was highest in normal persons, in patients with primary wide open-angle glaucoma and low-tension glaucoma. The greatest difference in IOP between subjects sitting and supine was observed in patients with low-tension glaucoma.     

Changes in intraocular pressure during prolonged (7-day) head-down tilt bedrest

PURPOSE: To determine the change in intraocular pressure (IOP) due to postural changes in young healthy volunteers. MATERIALS AND METHODS: Intraocular pressure was measured using a calibrated Pulsair noncontact tonometer in both eyes of 25 female volunteers in a sitting position and after 1, 3, and 10 minutes in a supine position. In the second part of the experiment (a 7-day -6 degrees head-down tilt [HDT]), IOP (at 8 am, 12 am and 6 pm) and corneal thickness (12 am) were monitored in 8 female volunteers before, during, and after the HDT period. Blood pressure, hematocrit, plasma volume and osmolality, and plasma catecholamines concentrations were also measured. RESULTS: Intraocular pressure was significantly higher in the supine position (16.1 +/- 3.6 mm Hg) than in the sitting position, with a mean pressure difference of 2.23 +/- 2.9 mm Hg after 1 minute, 0.9 +/- 3 mm Hg after 3 minutes, and 1.9 +/- 3.8 mm Hg after 10 minutes in a supine position (P < 0.001). During the period of HDT, IOP values decreased significantly on the fifth day (13.3 +/- 1.6 mm Hg, P = 0.03) and the seventh day (12.7 +/- 1.7 mm Hg, P = 0.02) when compared with IOP in the supine position (14.26 +/- 2 mm Hg). The corneal thickness increased significantly (P < 0.0001) at day 5 (549.25 +/- 48.7 microm) and day 7 (540.31 +/- 46.9 microm) compared with baseline (532.45 +/- 38.6 microm). Two days after the end of the HDT bedrest, the mean supine IOP significantly increased (14.1 +/- 1.8 mm Hg, P = 0.003) and corneal thickness was similar to that found at baseline. The mean decrease of IOP was positively correlated with that of the plasma volume (-10%, r = 0.61, P = 0.02) and negatively correlated with the mean rise of hematocrit (r = -0.5, P = 0.07), variables that are considered to be indirect measures of plasma dehydration. CONCLUSIONS: During a 7-day HDT bedrest experiment in healthy women, eyes seemed to compensate the moderate rise of IOP described between a sitting and a supine position, and exhibited a slight and progressive average decrease of 1.3 mm Hg. These physiological modifications could be related to an ocular dehydration or to systemic cardiovascular and hormonal variations during bedrest.     

Effect of latanoprost on intraocular pressure in steroid-induced glaucoma

PURPOSE: To study the effect of monotherapy with latanoprost 0.005% on intraocular pressure (IOP) in a prospective nonrandomized clinical trial of patients newly diagnosed with steroid-induced secondary open-angle glaucoma. PATIENTS AND METHODS: Eight patients (16 eyes) with newly diagnosed steroid-associated secondary open-angle glaucoma were prescribed latanoprost 0.005% once a day in each eye. The initial IOP before treatment served as an internal control for each eye. Intraocular pressure was remeasured after 1 month of monotherapy with latanoprost. Investigators (WJS) were blinded to initial IOP at the time of remeasurement. After discontinuation of steroids, IOP was rechecked. If IOP was stable, latanoprost was discontinued. Intraocular pressure was rechecked 2 to 4 weeks later to confirm an association with steroid use. RESULTS: Intraocular pressure was significantly decreased after treatment with latanoprost (18.3 +/- 2.8 mm Hg) compared with initial IOP (25.3 +/- 9.1 mm Hg). This change represented a 28% decrease in IOP compared with baseline levels. Average IOP after discontinuation of steroids and latanoprost (17.3 +/- 1.4 mm Hg) did not differ from IOP measured during treatment with latanoprost, but it was significantly less than the initial IOP before treatment. No adverse effects were noted. CONCLUSIONS: Monotherapy with latanoprost is safe and effective in patients with steroid-induced glaucoma. Advantages include lack of systemic side effects and convenient once-daily dosing.     

Intraocular pressure asymmetry and undiagnosed open-angle glaucoma in an older population

PURPOSE: To quantify prevalence of asymmetric intraocular pressure (IOP) and assess associations with undiagnosed open-angle glaucoma. DESIGN: Population-based cross-sectional study. METHODS: Participants underwent applanation tonometry. Intraocular pressure asymmetry was defined for differences > or = 3 mm Hg; open-angle glaucoma was diagnosed if glaucomatous optic disk and field changes were congruous. Analyses excluded subjects using glaucoma medication, known glaucoma, pseudoexfoliation, and cataract surgery. RESULTS: Intraocular pressure asymmetry was present in 5.1% of subjects and was greater for patients older than 70 years (6.2%). Of subjects with maximum IOP > 21 mm Hg, IOP asymmetry was present in 41.1%. Undiagnosed open-angle glaucoma was more frequent among subjects with (4.8%) than without (1.2%) IOP asymmetry. This relationship remained significant for maximum IOP < or = 21 mm Hg. CONCLUSIONS: Intraocular pressure asymmetry may be a useful sign of undiagnosed glaucoma in subjects without elevated IOP.     

Intraocular pressure-lowering effects of latanoprost and brimonidine therapy in patients with open-angle glaucoma or ocular hypertension: a randomized observer-masked multicenter study

PURPOSE: To compare the effect of treatment with latanoprost or brimonidine on intraocular pressure in patients with glaucoma or ocular hypertension and intraocular pressure inadequately controlled by monotherapy or dual therapy. PATIENTS AND METHODS: Three hundred seventy-nine patients with primary open-angle glaucoma or ocular hypertension were recruited for this 6-month prospective, randomized, observer-masked multicenter study involving 30 eye clinics. All patients were receiving monotherapy or dual therapy that did not adequately control intraocular pressure. After appropriate washout periods, patients were randomized to treatment with latanoprost once daily or brimonidine twice daily. The main outcome measure was change in mean diurnal intraocular pressure after 6 months of treatment compared with baseline. RESULTS: Of the 379 randomized patients, 375 were included in the intent-to-treat analysis. From an overall baseline mean intraocular pressure of 25.0 mm Hg, latanoprost monotherapy reduced mean diurnal intraocular pressure by 7.1 +/- 3.3 mm Hg (mean +/- SD, P < 0.001), whereas brimonidine monotherapy yielded an intraocular-pressure reduction of 5.2 +/- 3.5 mm Hg (P < 0.001). This 1.9 mm Hg difference in intraocular-pressure reduction was significantly in favor of latanoprost (P < 0.001). Ocular allergy (P < 0.001) and systemic side effects (P = 0.005) were reported significantly less frequently by latanoprost-treated patients compared with brimonidine-treated patients. CONCLUSIONS: Both latanoprost and brimonidine reduced intraocular pressure in patients with glaucoma or ocular hypertension after 6 months of treatment. However, latanoprost once daily was significantly more effective than brimonidine twice daily in reducing mean diurnal intraocular pressure. Latanoprost was better tolerated with less frequently occurring ocular allergy and systemic side effects.     

Relation between office intraocular pressure and 24-hour intraocular pressure in patients with primary open-angle glaucoma treated with a combination of topical antiglaucoma eye drops

PURPOSE: To determine the relation between office intraocular pressure (IOP) and 24-hour IOP in patients with primary open-angle glaucoma (POAG) treated with 3 kinds of antiglaucoma eye drops. PATIENTS AND METHODS: Subjects were 42 patients with POAG (71 eyes). All were being treated with 3 different topical antiglaucoma eye drops (latanoprost, beta-blocker, and carbonic anhydrase inhibitor). Twenty-four-hour IOP values were obtained in the sitting position with a Goldmann applanation tonometer at 3-hour intervals. RESULTS: Maximum 24-hour IOP (mean+/-SD) was 19.76+/-5.65 mm Hg, minimum 24-hour IOP was 13.06+/-4.75 mm Hg, mean 24-hour IOP was 16.30+/-4.90 mm Hg, and 24-hour IOP fluctuation was 6.70+/-2.81 mm Hg. Office IOP was 16.23+/-4.58 mm Hg, and office IOP fluctuation was 2.75+/-1.68 mm Hg. There was no significant difference between office IOP and mean 24-hour IOP (P=0.93). There was no correlation between office IOP and 24-hour IOP fluctuation (r=0.15; P=0.25) or between office IOP fluctuation and 24-hour IOP fluctuation (r=0.19; P=0.17). Maximum 24-hour IOP occurred during office hours in 22 eyes (33.8%). The frequency of maximum 24-hour IOP occurring during office hours was significantly less than that of minimum 24-hour IOP (P<0.001). CONCLUSIONS: In POAG patients treated with 3 kinds of antiglaucoma eye drops, office IOP was similar to mean 24-hour IOP. However, it was difficult to estimate 24-hour IOP fluctuation and maximum 24-hour IOP on the basis of office IOP.     

Postural change of intraocular and blood pressures in ocular hypertension and low tension glaucoma.

The effect of body position on the intraocular and blood pressures of normal volunteers and of patients with ocular hypertension and low tension glaucoma was studied. Changing from the sitting to the supine position increased the intraocular pressure by an average of 4.4 (SD 2.0) mm Hg in the control group, 4.0 (SD 2.0) mm Hg in the ocular hypertension group, and 4.1 (SD 1.8 mm Hg) in the low-tension glaucoma group. After 30 minutes in the supine position the intraocular pressure in normal volunteers and patients with low tension glaucoma remained stable. In contrast patients with ocular hypertension showed a further significant increase in intraocular pressure of 1.6 (SD 2.8) mm Hg (p = 0.004). This was accompanied by an equally significant decrease in blood pressure (p less than 0.001). We believe that these are manifestations of different mechanism of intraocular pressure regulation between these groups.     

体位对青光眼患者眼压的影响

目的：研究不同体位对青光眼患者眼压的影响。 方法：选择术前住院患者原发性开角型、闭角型青光眼和正常眼压者各30例,测量其坐位、半坐卧位、仰卧位、侧卧位、俯卧位时眼压的变化;观察30例住院的青光眼患者眼压增高时体位的情况。 结果：三组患者不同体位所测平均眼压值中,均以卧位最高。左右侧卧位时下一侧眼的眼压比上一侧眼的眼压高。两两比较时坐位与半坐卧位、仰卧位与俯卧位之间眼压值无统计学意义（P＞0.05）。仅坐位、半坐卧位与各种卧位之间比较,差异均具有统计学意义（P＜0.05）。观察30例住院的青光眼患者眼压增高时以患侧卧位为主占70%,患者不能躺卧,被迫坐位。 结论：青光眼患者采取头高位及避免患眼侧卧位有利于眼压的控制。     

Argon laser trabeculoplasty in younger patients with primary open-angle glaucoma

We conducted a retrospective comparison of the effectiveness of argon laser trabeculoplasty in controlling increased intraocular pressure in two different age groups treated for medically uncontrolled primary open-angle glaucoma. Of 15 eyes of patients less than 40 years old who had primary open-angle glaucoma, nine (60%) had uncontrolled intraocular pressures postoperatively and needed filtering surgery within two years of argon laser trabeculoplasty. Only two of 29 (7%) eyes in older patients had unacceptably high intraocular pressures during a mean (+/- 1 S.D.) follow-up period of 17 +/- 5 months. Older eyes had greater decreases in intraocular pressure (12 +/- 6 mm Hg) than younger eyes (5 +/- 6 mm Hg) after laser treatment. Failure in young eyes appeared to correlate with a high preoperative intraocular pressure. Thus, argon laser trabeculoplasty is not a reliably effective form of therapy for younger patients with primary open-angle glaucoma.     

Nocturnal measurements of intraocular pressure in patients with normal-tension glaucoma and sleep apnea syndrome

BACKGROUND: About half of all normal-tension glaucoma patients and about one third of all primary open-angle glaucoma patients have sleep apnea syndrome. If sleep apnea syndrome causes some cases of glaucoma, the optic nerve damage could result from repetitive nocturnal hypoxias or from repetitive intraocular pressure elevations at the end of the apneas. In this study, we determined the intraocular pressure at the end of long apneas. PATIENTS AND METHODS: In three patients having sleep apnea syndrome and normal-tension glaucoma we recorded in a sleep laboratory during at least six hours of sleep the respiration (oxymetry, nasal and oral air flow, and inductive plethysmography). The intraocular pressure was measured with a pneumatonometer at predetermined times and compared to the values measured at the end of prolonged apneas. RESULTS: The intraocular pressure during normal respiration was in the first patient 19.5 +/- 1.0 mm Hg OD and 19.3 +/- 1.7 mm Hg OS, in the second patient 25.0 +/- 4.2 respectively 25.5 +/- 4.9 mm Hg and in the third one 22 +/- 1.0 respectively 21.3 +/- 1.3 mm Hg. At the end of prolonged apneas the intraocular pressure was in the first patient 19.0 +/- 0.0 mm Hg OD and 19.5 +/- 0.7 mm Hg OS, in the second patient 26.5 +/- 0.6 and 26.8 +/- 0.1 mm Hg and in the third one 20.0 +/- 0.0 respectively 21.0 +/- 0.0 mm Hg. The difference between intraocular pressures during normal respiration and at the end of prolonged apneas was not significant (p > 0.1 for each comparison, paired t-test). CONCLUSIONS: We did not find an increase of intraocular pressure at the end of prolonged apneas compared to periods of normal respiration in patients with sleep apnea syndrome and normal-tension glaucoma. If sleep apnea syndrome causes some cases of glaucoma, it seems more probable that the the optic nerve is damaged by the repetitive hypoxias. Alternatively, an unknown factor might induce both, sleep apnea syndrome and normal-tension glaucoma.     

Status of blood supply to the eye in patients with primary open-angle glaucoma depending on the value of systemic arterial pressure and level of ophthalmic tone

Blood supply to the eye was studied in 756 patients aged 40-82 years (1339 eyes) with primary open-angle glaucoma, systemic arterial pressure (AP) 105-170 mm Hg, and various level of intraocular pressure (IOP). Control group consisted of 340 healthy subjects (680 eyes) aged 28-80 years without ophthalmic diseases with the same AP values. Blood supply values in the controls were taken for the norm. They were in high correlation with systemic AP. Ocular blood supply in patients with primary open-angle glaucoma depends on systemic AP and IOP, particularly perfusion pressure (Pperf) which decreases by 3.1 mm Hg in patients with systemic AP of 126-139 mm Hg and moderately (from normal to moderate) increased IOP. If IOP increases in the interval from moderate to high in patients with the same AP, Pperf drops by 12.5 mm Hg. Pperf values indicate deterioration of ocular blood supply in patients with primary open-angle glaucoma and different levels of IOP.     

Goniocurettage for removing trabecular meshwork: clinical results of a new surgical technique in advanced chronic open-angle glaucoma.

PURPOSE: To elucidate the long-term outcome of goniocurettage as a new technique in trabecular microsurgery for advanced open-angle glaucoma. METHODS: In a prospective, nonrandomized clinical trial, 25 eyes of 25 patients with a mean age +/- SD of 72.7+/-10.1 years (range, 50 to 89 years) with uncontrolled chronic open-angle glaucoma that had undergone failed filtering procedures were treated by goniocurettage. Trabecular tissue was scraped away from the chamber angle by means of an instrument similar to a microchalazion curette (diameter, 300 microm). RESULTS: Before surgery, intraocular pressure ranged from 29 to 48 mm Hg (mean +/- SD, 34.7+/-7.1 mm Hg), and mean number of antiglaucoma medications was 2.2+/-0.56. Follow-up averaged (+/-SD) 32.6+/-8.1 months (range, 30 to 45 months). Overall success, defined as postoperative intraocular pressure of 19 mm Hg or less with one pressure-reducing agent, was attained in 15 eyes (60%), with five eyes (20%) being controlled without medication. Considering all successfully treated patients, the mean intraocular pressure was 17.7+/-3.1 mm Hg (range, 10 to 19 mm Hg) at the final visit. Mean intraocular pressure reduction was 17.1+/-7.1 mm Hg in these eyes, representing a net decrease from baseline of 49%. Number of antiglaucoma medications dropped to 0.63+/-0.29. Complications included localized Descemet membrane detachment in five eyes (20%) and moderate anterior chamber bleeding in four eyes (16%). CONCLUSIONS: This new surgical technique can effectively control intraocular pressure for long periods of time in patients with open-angle glaucoma and a history of failed filtering procedures. Goniocurettage may be a suitable alternative to surgical treatment of glaucoma patients with excessive conjunctival scarification.     

Comparison of ocular hypotensive effect and safety of brinzolamide and timolol added to latanoprost

PURPOSE: To compare the ocular hypotensive effect and safety of brinzolamide and timolol added to latanoprost monotherapy. METHODS: In prospective randomized fashion, we evaluated the ocular hypotensive effect and safety of brinzolamide or timolol in 1 eye of 32 patients with primary open-angle glaucoma, normal-tension glaucoma, or ocular hypertension who had been treated with latanoprost for more than 1 month. Intraocular pressure (IOP), blood pressure, and pulse were measured before and at 4, 8, and 12 weeks. Corneal endothelial cell density was measured at baseline and at 12 weeks. RESULTS: The IOP was 17.8+/-1.7 mm Hg (mean+/-SD) before the addition of brinzolamide (n=15) and 15.7+/-2.1 mm Hg at 12 weeks (P<0.01). In comparison, the IOP was 18.5+/-3.7 mm Hg before the addition of timolol (n=15) and 15.8+/-3.2 mm Hg at 12 weeks (P<0.01). Both brinzolamide and timolol significantly decreased IOP at 12 weeks, by a mean of 2.0 mm Hg and mean 2.7 mm Hg, respectively, and were more effective than latanoprost alone (P<0.01), but there were no significant differences between the drugs and no significant differences in corneal endothelial cell density and blood pressure before and after addition of either drug. At 12 weeks, pulse was decreased in patients receiving timolol (P<0.01). As systemic adverse events, there was one instance of malar flushing after brinzolamide addition and episodes of chest discomfort after timolol addition in 1 patient. Ocular adverse events were slight. CONCLUSIONS: Brinzolamide and timolol added to latanoprost have similar ocular hypotensive effects and safety in primary open-angle glaucoma, normal-tension glaucoma, or ocular hypertension.     

Intraocular pressure and progression of glaucomatous visual field loss

PURPOSE:To evaluate the relationship between intraocular pressure and visual field progression in patients with primary open-angle glaucoma.METHODS:We prospectively followed 113 patients with early to moderate glaucomatous field damage. Conventional automated static perimetry, high-pass resolution perimetry, and intraocular pressure measurements were carried out at 6-month intervals. The mean and the highest intraocular pressure in the follow-up were compared in stable and progressing patients with each perimetric technique. RESULTS:The mean (+/- SD) follow-up was 4.5 +/- 0.9 years. The mean (+/- SD) intraocular pressure in patients remaining stable with conventional perimetry [18.2 +/- 3.3 mm Hg, n = 81 (71.7%)] was not significantly different (P =.65) from those in whom it progressed (17.9 +/- 3.3 mm Hg, n = 32 [28.3%]). The mean intraocular pressure in patients remaining stable with high-pass resolution perimetry (17. 9 +/- 3.5 mm Hg, n = 63 [55.8%]) was not significantly different (P =.33) from those in whom it progressed (18.5 +/- 3.0 mm Hg, n = 50 [44.2%]). The mean (+/- SD) of the highest (single or three highest) pressure during follow-up for stable and progressing patients with conventional perimetry was not significantly different (22.6 +/- 5.0 and 23.0 +/- 4.6 mm Hg, respectively, P =.76). However, for high-pass resolution perimetry, the difference was highly significant (21.6 +/- 4.5 and 24.1 +/- 4.9 mm Hg, respectively, P <. 01). Furthermore, patients who progressed with high-pass resolution perimetry had more damaged baseline fields compared with those who remained stable (P <.01).CONCLUSIONS:The mean level of intraocular pressure does not differentiate glaucoma patients with progressive visual field loss from ones who remained stable. Baseline visual field status and peak intraocular pressure of patients who progress with high-pass resolution perimetry are significantly different from those who remain stable.     

Augeninnendruckmessungen im Tages- und Nachtverlauf bei Glaukompatienten und Normalprobanden mittels Goldmann- und Perkins-Applanationstonometrie

OBJECTIVE: Our aim was to evaluate intraocular pressure (IOP) levels in primary open angle glaucoma (POAG) patients and healthy controls during both the day and night while measuring in an upright as well as in a supine position. METHODS: In a prospective clinical trial, 30 glaucoma patients on topical treatment and 50 healthy controls received IOP measurements every 4 h for a 24 h period starting at 8 am. Additionally, blood pressure and heart rate were measured and perfusion pressures were calculated. At 12 am IOP was initially measured in a sitting position and then, after 20 min, in a supine position. At midnight this was carried out conversely. At 4 am IOP was measured in a supine position; all other measurements were performed in a sitting position. Measurements in the sitting position were performed by Goldmann and Perkins tonometry and in a supine position by Perkins tonometry. RESULTS: IOP was 1 mmHg lower in Perkins tonometry measurements compared to Goldmann tonometry. There was no difference between the two patient groups. In a supine position, IOP measured by Perkins tonometry was higher than in an upright position. At 12 am the difference was 1.8 mmHg+/-2.7 mmHg (p=0.001) in healthy subjects and 1.3+/-2.7 mmHg (p=0.013) in the POAG patients. At 12 pm the increase of IOP in the supine position was even more pronounced with 2.4+/-3.4 mmHg in healthy subjects and 5.6+/-3.2 mmHg in the POAG patients (p=0.001). The blood pressure and the perfusion pressure were lowest during night measurements. CONCLUSIONS: During diurnal IOP measurements in an upright position there were no statistically significant differences in IOP changes between groups. However, in a supine position IOP was significantly higher than in a sitting position and increased more in the glaucoma patients than in healthy controls. This observation might be due to a faulty regulation of the fluid shift in glaucoma patients and could cause progression of glaucomatous damage.