高眼压症及原发性开角型青光眼患者的24 h眼压波动规律

目的 通过24 h眼压测量来深入分析对比高眼压症与原发性开角型青光眼(POAG)患者的眼压曲线特征。方法 收集2016年1月~2019年3月在我科门诊诊断为高眼压症的患者52例(104眼)及POAG尚未接受降眼压治疗的患者38例(76眼)。入院后行24 h眼压检查,用非接触性眼压计从早9时起每隔2 h测量眼压1次,至次日7时结束。分析2组患者的平均眼压,峰值眼压及时间点,谷值眼压及时间点,昼夜眼压波动及双眼眼压压差值及其分布情况,比较2组眼压波动的异同点。结果 104眼高眼压症患者的平均眼压为(18.73±1.71)mmHg(1 mmHg=0.133 kPa),平均峰值眼压为(22.36±2.40) mmHg,平均谷值眼压为(15.63±2.09) mmHg,平均昼夜眼压波动为(6.72±2.24) mmHg。76眼POAG患者的平均眼压为(20.65±2.53) mmHg,平均峰值眼压为(25.78±2.81) mmHg,平均谷值眼压为(17.45±2.54) mmHg,平均昼夜眼压波动为(8.34±2.37) mmHg。2组的峰值及谷值眼压值分布最多的时间点均为凌晨3时及夜晚21时,大部分患者的峰值眼压时间点在门诊时间之外。高眼压症组中昼夜眼压波动位于5~8 mmHg的占比最大,为54.81%(57/104),POAG组中昼夜眼压波动>8 mmHg的占比最大,为53.95%(41/76)。高眼压症组中,16例患者经24 h眼压检查后监测到眼压波动异常,占比为30.77%(16/52);POAG组中经24 h眼压检查后有29例患者可以监测到眼压波动异常,占比为76.32%(29/38)。结论 24 h眼压监测中,POAG患者较高眼压症患者的平均眼压、峰值眼压、谷值眼压、昼夜眼压波动及双眼压差均有增加。对于24 h眼压发现眼压波动较大的高眼压症患者应在后续加强密切随访,而对于POAG患者24 h眼压监测可在治疗前提供眼压的基线水平,为后续治疗提供参考及评估依据,因此建议将24 h眼压作为高眼压症及POAG的常规检查手段。     

Comparison of 24-hour intraocular pressure reduction with two dosing regimens of latanoprost and timolol maleate in patients with primary open-angle glaucoma.

PURPOSE: To compare the 24-hour diurnal ocular hypotensive efficacy of two dosing regimens of latanoprost, once daily (8 AM or 10 PM), vs timolol maleate, twice daily. METHODS: We measured six diurnal intraocular pressure curves (6 AM, 10 AM, 2 PM, 6 PM, 10 PM, and 2 AM) in one randomly selected eye of 34 Greek patients newly diagnosed with primary open-angle glaucoma. The first diurnal curve was an untreated baseline. Patients began taking timolol 0.5%, twice daily, for 2 months. Patients were randomly assigned to latanoprost 0.005% given at 8 AM or 10 PM for 1 month and then changed to the other dosing regimen for 1 month. A diurnal curve was performed after each dosing period. RESULTS: The baseline diurnal pressure for all 34 subjects was 23.1 +/- 3.7 mm Hg. The average intraocular pressures at 6 AM for patients who were given latanoprost in the evening (17.9 +/- 2.9 mm Hg) was statistically lower than that in patients given timolol solution (20.1 +/- 2.5 mm Hg, P = .003); however, patients who were given timolol demonstrated a similar diurnal intraocular pressure (19.1 +/- 2.8 mm Hg) to both morning (18.8 +/- 3.7 mm Hg) and evening doses (18.8 +/- 3.6 mm Hg) of latanoprost (P =.329). When the two latanoprost dosages were compared directly, evening administration provided a statistically lower intraocular pressure at 10 AM (P = .0001) and morning administration at 10 PM (P = .0001). This study had an 80% power to exclude a 1.2-mm Hg difference between groups. CONCLUSIONS: This study indicates that in a small population, both latanoprost and timolol are effective in lowering intraocular pressure throughout a 24-hour period; however, latanoprost is most effective in the 12-hour to 24-hour period after administration.     

Effects of ibopamine eye drops on intraocular pressure and aqueous humor flow in healthy volunteers and patients with open-angle glaucoma

PURPOSE: On the basis of intraocular pressure measurements and fluorophotometry we assessed the effects of 2% ibopamine eye drops on aqueous humor production in normal and glaucomatous eyes. METHODS: Thirty subjects (15 healthy volunteers and 15 open-angle glaucoma patients with ocular hypertension) were included in a placebo-controlled study with random assignment of treatment from masked containers. All subjects underwent ophthalmologic examinations and intraocular pressure (IOP) measurements. Fluorophotometry was done in both eyes at baseline (without treatment) and during treatment. Each subject was treated with 1 drop of 2% ibopamine in one eye and 1 drop of placebo in the fellow eye 30 minutes before fluorophotometric scans and every hour after the first instillation (for a total of 4 times). Safety was evaluated by recording adverse events and ocular symptoms and signs. Aqueous humor flow data were analyzed using the paired t-test, comparing ibopamine and placebo-treated eyes. RESULTS: No changes in IOP were detected in normal eyes, whereas glaucomatous eyes showed a mean increase of 4 mmHg (95% CI 3.46-4.51) from baseline. The difference in IOP between healthy eyes and those with glaucoma was significant (p < 0.0001). In normal eyes and patients with glaucoma ibopamine led to a significant increase in aqueous humor flow compared with placebo-treated eyes (p < 0.01). The safety profile of ibopamine was very good. CONCLUSIONS: The results seem to confirm that ibopamine increases aqueous humor production in normal and glaucomatous eyes, raising IOP only in eyes with glaucoma.     

Prostaglandin F2 alpha-isopropylester eye drops: effect on intraocular pressure in open-angle glaucoma.

In 30 patients with previously untreated open-angle glaucoma an intraocular pressure (IOP) curve was taken before and during treatment with PGF2 alpha-isopropylester (PGF2 alpha-IE) eye drops in one eye. Compared with the pretreatment IOP, the PGF2 alpha-IE induced a slowly increasing reduction in IOP. Just before the first dose the IOP was 31.4 (SEM 1.6) mm Hg. When corrected for the fall in pressure observed in the fellow eye the largest reduction, 5.8 (SEM 0.7) mm Hg (p less than 0.001), was obtained 24 hours later, that is, 12 hours after the second dose. In a subgroup of 10 patients the treatment was continued for one week. In this group the final pretreatment IOP was 25.9 (SEM 1.3) mm Hg. The reduction 24 hours later was 4.5 (SEM 0.6) mm Hg (p less than 0.001). The effect was maintained and even slightly increased during the week, and on the seventh day of treatment the IOP reduction ranged between 4.8 and 7.6 mm Hg compared with the pretreatment IOP. No serious subjective or objective side effects were observed.     

The effects of 2% ibopamine eye drops on the intraocular pressure and pupil motility of patients with open-angle glaucoma

PURPOSE: Ibopamine is a prodrug of N-methyldopamine that has a non-cycloplegic mydriatic action due to its alpha-adrenergic properties and is able to induce, when topically given, a transient increase of intraocular pressure (IOP) in eyes with hydrodynamic disorders. METHODS: This is a randomized, crossover, open-labeled, two- center study. Forty patients (20 open-angle glaucoma patients and 20 healthy subjects) were treated with ibopamine 2% eye drops and phenylephrine 10% eye drops. RESULTS: Ibopamine induced a significant increase in IOP only in glaucomatous eyes (p<0.001) without a significant hypertensive effect in normal eyes. Ibopamine and phenylephrine showed a similar mydriatic activity but ibopamine was able to induce an hypertensive effect only in glaucomatous eyes. CONCLUSIONS: The results confirm the use of ibopamine as provocative test in detection of hydrodynamic disorders.     

Correlation between intraocular pressure control and progressive glaucomatous damage in primary open-angle glaucoma

Fifty-five patients with primary open-angle glaucoma and early glaucomatous damage who had medical therapy and laser trabeculoplasty were followed up for four to 11 years or until progressive glaucomatous damage was documented. Factors associated with the stability or progression of glaucoma were evaluated. Eyes with mean intraocular pressure higher than 21 mm Hg during the follow-up period uniformly had progressive glaucomatous changes. Conversely, eyes with mean intraocular pressure less than 17 mm Hg remained stable, and approximately half of the eyes with mean intraocular pressure between 17 and 21 mm Hg had progressive glaucomatous changes. Patients who remained stable were slightly younger than those with progressive glaucomatous changes (P less than .05), but initial optic nerve head appearance, initial visual field findings, number of medicines used, medical history, and patient gender or race were not statistically associated with stability or progression of the glaucoma. These findings reinforce the importance of intraocular pressure control in primary open-angle glaucoma and the need to identify other markers that help determine the proper level of intraocular pressure for individual patients.     

Long-term relationship between intraocular pressure and visual field loss in primary open-angle glaucoma

PURPOSE: To investigate the dependence upon intraocular pressure (IOP) of the progression of visual field defects in eyes with primary open-angle glaucoma (POAG), in which the mean IOP was maintained at < or =21 mm Hg. METHODS: This study involved 100 eyes with POAG, which were followed up for > or =5 years. The mean IOP levels were maintained at < or =21 mm Hg during the follow-up period. The relationship between the IOP and the progression of visual field defects, which was scored using the Advanced Glaucoma Intervention Study criteria, was investigated retrospectively. RESULTS: Compared with the baseline scores, the visual field defect scores had significantly worsened by the end of the follow-up period (P<0.0001, Wilcoxon paired signed rank test). The change in the visual field defect score (2.5+/-0.5) in eyes with average IOP levels of > or =16 mm Hg (n=36) was significantly greater (P=0.031, Mann-Whitney U test) than the change (1.3+/-0.3) in eyes with average IOP levels of <16 mm Hg (n=64). Moreover, IOP of > or =18 mm Hg made a major contribution to the aggravation of visual field defects in eyes with POAG. CONCLUSIONS: Eyes with POAG and with mean IOP levels maintained at < or =21 mm Hg underwent IOP-dependent progression of their visual field defects. Our results suggest that further IOP lowering would be beneficial in such cases.     

有无前列腺素类药物对眼压控制的原发性开角型青光眼患者24 h眼压的影响

目的 比较通过药物治疗眼压得到控制(峰压≤21 mm Hg)的原发性开角型青光眼(POAG)患者单用或联合应用前列腺素类(PGs)药物(有PGs组)和单用或联合应用其它降眼压药物(无PGs组)的24h眼压测量结果.方法 对经药物治疗后连续3个以上时间点测量的最高眼压值≤21 mm Hg的38例POAG患者(64只眼)于末次就诊的1周内进行24h眼压测量,对比分析有PGs组(20例31只眼)和无PGs组(18例33只眼)的测量结果(波动幅度、眼压峰值和平均眼压).结果 有PGs组和无PGs组的24h眼压波动幅度均值分别为(4.19±1.60)mm Hg、(5.63±1.71)mm Hg,差异有统计学意义(-3.479,P＜0.01);两组的眼压峰值均数分别为(17.81±1.68) mm Hg、(18.79±1.41)mm Hg,差异有统计学意义(t=-2.537,P＜0.05);有PGs组的平均眼压(15.89±1.68) mmHg低于无PGs组(15.96±1.53) mmHg,但差异无统计学意义(t=0.182,P＞0.05).结论 通过药物治疗眼压得到控制的POAG患者中,尽管两组24h眼压测量的平均眼压没有差别,但有PGs组的波动值和眼压峰值均低于无PGs组,提示PGs比其他药物对24h眼压的控制效果更好.     

Water-drinking test in patients with primary open-angle glaucoma while treated with different topical medications.

OBJECTIVE: Reduction and diurnal stabilization of the intra-ocular pressure (IOP) is the mainstay of treatment for glaucoma. Fluctuations of IOP in glaucomatous patients can also be induced by the osmotic variations caused by water ingestion. Such influence can be studied by means of the water-drinking test (WDT). The aim of this study was to perform the WDT in patients with primary open-angle glaucoma (POAG) while they were being treated with different IOP-lowering medications, to test the effect of drugs with different mechanisms of action on the ability to maintain a stable IOP. METHODS: A total of 280 POAG patients were enrolled, 40 patients per group for each of the tested medications (timolol, dorzolamide, brinzolamide, travoprost,latanoprost, bimatoprost, and brimonidine). After baseline IOP measurement, all patients underwent WDT (1000 mL of water in 10 min). The IOP was measured at 15-min intervals until the return of IOP to baseline values. The main outcomes measured were mean IOP peak, mean IOP percentage increase, and mean time for returning to baseline IOP value. RESULTS: The highest mean IOP peak was found with timolol, whereas no difference was found among the other drugs. The highest mean IOP percentage increase was found with timolol, whereas bimatoprost showed an IOP percentage increase significantly lower than latanoprost, dorzolamide, and brinzolamide. The duration of IOP increase was shortest for bimatoprost and longest for timolol. CONCLUSION: This study suggests that topical medications that enhance outflow (e.g., bimatoprost, latanoprost, travoprost, and brimonidine) may provide, under stressful conditions such as the WDT, better IOP stabilization than medications that decrease aqueous humor inflow, such as timolol and topical carbonic anhydrase inhibitors.     

Comparison of additional intraocular pressure-lowering effects of latanoprost vs brimonidine in primary open-angle glaucoma patients with intraocular pressure uncontrolled by timolol-dorzolamide combination

PURPOSE: To compare the additive intraocular pressure (IOP)-lowering effects of latanoprost 0.005% and brimonidine 0.2% in primary open-angle glaucoma (POAG) patients uncontrolled on fixed combination of timolol 0.5% and dorzolamide 2% (TDC) alone. METHODS: In all, 80 eyes of 80 POAG patients with IOP inadequately controlled by TDC were randomly assigned to receive either latanoprost 0.005% or brimonidine 0.2%. IOP measurements were recorded at 1000 (peak effect) and 1600 (trough effect) on day 0 (baseline) and at 1 and 3 months. At each stage and time point, the mean IOP reductions from baseline were evaluated for both groups, and success rates (minimum 15% reduction) were determined. RESULTS: At baseline, the mean peak/trough IOPs with TDC were 20.2/21.6 and 19.9/21.4 mmHg in latanoprost and brimonidine groups, respectively. Latanoprost+TDC reduced the mean peak/trough IOP by 4.4/3.4 and 5.2/3.5 mmHg at 1 and 3 months. The corresponding values for brimonidine+TDC were 3.9/2.9 and 4.6/2.9 mmHg. Each of these results represented a significant reduction from baseline (P<0.001 for all); however, the groups' peak/trough reductions from baseline did not differ at any time point (P>0.05 for all). With the latanoprost+TDC combination, the peak/trough success rates at 1 and 3 months were 76.3%/42.1% and 77.1%/40%. The corresponding values with the brimonidine+TDC combination were 71.8%/41% and 77.7%/41.7%. There were no significant differences in the groups' success rates at any time point (P>0.05 for all). CONCLUSION: Addition of latanoprost 0.005% or brimonidine 0.2% to TDC reduces peak/trough IOPs significantly and the effects of these combinations are comparable.     

Relationship between intraocular pressure,anterior chamber depth and lens thickness in primary open-angle glaucoma patients

Introduction

To investigate the relationship between intraocular pressure (IOP), anterior chamber depth (ACD) and lens thickness (LT) in primary open-angle glaucoma (POAG) patients and compare with age- and sex-matched controls.

Methods

A cross-sectional analytical study of 62 newly diagnosed POAG patients compared with 62 age- and sex-matched control subjects in a tertiary eye clinic. Socio-demographic data and ocular examinations were documented. IOP was measured using the Goldmann applanation tonometer. LT and ACD were measured using A-scan ultrasonography and the IOLMaster, respectively. Data were analyzed using SPSS version 19.0 and level of significance set at p value <0.05.

Results

In the glaucoma group and control groups, respectively, mean age was 60.3 ± 8.9 and 58.5 ± 8.1 years (p = 0.234), mean IOP was 28.27 ± 7.88 and 14.47 ± 2.60 mmHg (p < 0.001), mean ACD was 3.12 ± 0.27 and 3.15 ± 0.24 mm (p = 0.514), mean LT was 4.24 ± 0.46 and 4.23 ± 0.45 mm (p = 0.903), and mean ACD was shallower in females (p = 0.034) and (p = 0.001). In the glaucoma group, there was a positive correlation between IOP and ACD (r = 0.022, p = 0.864), but a negative correlation between IOP and LT (r = ?0.04, p = 0.758) and ACD and LT (r = ?0.058, p = 0.657). In the control group, there was a positive correlation between IOP and ACD (r = 0.141, p = 0.275), IOP and LT (r = 0.031, p = 0.811) and ACD and LT (r = 0.016, p = 0.901).

Conclusion

ACD is shallower in females. There is no significant correlation between IOP and ACD or between IOP and LT in POAG as well as normal individuals.