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 curves in ocular hypertension and primary open-angle glaucoma

Objective To analyze the characteristics of diurnal intraocular pressure (IOP) curves in ocular hypertension patients (OHT) and primary open-angle glaucoma (POAG) patients by 24-hour IOP monitoring. Methods Subjects were enrolled from the outpatients of Huadong Hospital of Fudan University who were diagnosed as OHT and POAG from January 2016 to January 2019.A total of 52 OHT patients and 38 POAG patients were included in this study.All the subjects accepted 24-hour IOP measurements using non-contact tonometer every two hours starting from 9am to 7am next morning.The average IOP, peak IOP, valley IOP and diurnal IOP fluctuations were analyzed. The distribution of time points of peak and valley IOP were also described. Results The average IOP was 18.73±1.71 mmHg in OHT patients, while the average IOP was 20.65±2.53 mmHg in POAG patients. The peak IOP in the OHT group were 22.36±2.40 mmHg, and in the POAG group were 25.78±2.81 mmHg. The valley IOP in the OHT group were 15.63±2.09 mmHg, and in the POAG group were 17.45±2.54 mmHg. Compared with other time points, the cases of peak IOP at 3am and of valley IOP at 9pm were the most. Notably, about half of the peak IOP was outside the office time. The IOP fluctuation in the range of 5 to 8 mmHg was the most in OHT group, accounting for 54.81%(57/104). The IOP fluctuation over 8 mmHg was the most in POAG group, accounting for 53.95%(41/76). In OHT group, 16 of 52 patients had been detected with excessive range of IOP fluctuations, while the value of POAG group was much higher (29/38). Conclusions 24-hour IOP monitoring could provide valuable information for OHT patients to predict the possibility of developing POAG and provide the pretreatment IOP baseline. If conditions permit, 24-hour IOP monitoring could be served as a regular examination in OHT and POAG patients.