药物治疗中的青光眼患者自我监测24小时眼压的临床效果

目的：评估自我监测24 h眼压在药物治疗原发性开角型青光眼（POAG）患者中的临床效果。方法： 系列病例研究。选取2017年8月至2019年1月就诊于沈阳爱尔眼视光医院行药物治疗且随访眼压控制良 好的POAG患者42例（73眼），根据基线眼压分为A组：眼压为（12.86±1.40）mmHg（1 mmHg=0.133 kPa）； B组：眼压为（17.82±1.40）mmHg。入组患者通过iCare HOME回弹式眼压计使用培训认证后于家中 自行测量24 h眼压，自730起每隔2 h测量1次，夜间2330-530测量苏醒后即刻的坐位眼压。比 较组间各时间段眼压均值、峰值及波动值，并统计眼压峰值时间点和更改治疗方案的患者比例。数 据采用单因素方差分析、Kruskal-Wallis H检验、t检验以及χ2 检验进行分析。结果：入组患者随访、 门诊时间以及24 h的平均眼压总体差异无统计学意义（F=1.314，P=0.271）。入组患者24 h眼压峰值高 于门诊时间的眼压峰值、随访眼压峰值（H=-40.979、-51.363，均P<0.001）。83.6%的患者眼压峰值 出现在非门诊时间（A组86.5%、B组80.6%），尤其是发生在夜间睡眠时间，其比例高达67.1%（A组 64.9%、B组69.4%）。入组患者以及A、B亚组患者的24 h眼压波动值均高于其门诊时间眼压波动 值（t=11.166、8.110、7.929，均P<0.001），其中63.0%的患者24 h眼压波动值≥8 mmHg（A组51.4%、 B组75.0%）。根据自我监测24 h的眼压结果，49.3%的患者更改治疗方案，且B组患者更改比例（63.9%） 高于A组（35.1%），差异有统计学意义（χ2 =6.035，P=0.014）。结论：药物治疗中的POAG患者自行监测 24 h眼压，能发现临床常规随访中无法监测到的眼压峰值和波动值，可作为医师评价疗效和调整治疗 方案的重要依据。

Clinical Effect of Self-Monitoring 24-Hour Intraocular Pressure in Medical Treated Glaucoma Patients

Objective: To evaluate the clinical significance of self-monitoring 24-hour intraocular pressure (IOP) in primary open angle glaucoma (POAG) patients with medical treatment. Methods: This was a case series study. Forty-two POAG patients who had acceptable clinic IOP reading controlled by medicine were selected in shenyang Aier Eye Hospital from August 2017 to January 2019, and divided into group A (IOP: 12.86±1.40 mmHg) and group B (IOP: 17.82±1.40 mmHg) based on the baseline IOP. All participants were trained to use the iCare HOME rebound tonometer to measure 24-hour IOP at home by themselves after certification. 24-hour IOP values was obtained every 2 hour starting from 7:30. The IOP was measuredimmediately in sitting position after waking up during 23:30 to 5:30. The observation indices included mean IOP, peak IOP and IOP fluctuation amplitude in different periods. The timing of peak IOP and the proportion of patients changing treatment were counted. One-way ANOVA, Kruskal-Wallis H test, t-tests and χ2 test were used to analyze the data. Results: There was no significant difference among the mean IOP measured in the period of clinic, office hours and 24-hour (F=1.314, P=0.271). The peak IOP during 24-hour was higher than that during office hours and that during the clinic period (H=-40.979, -51.363, all P<0.001). 83.6% of the patients' peak IOP occurred outside the office hours (86.5% in group A and 80.6% in group B), especially in the night, with a proportion as high as 67.1% (64.9% in group A and 69.4% in group B). The 24-hour IOP fluctuation of all patients, as well as the patients in group A and group B, were higher than that during office hours (t=11.166, 8.110, 7.929, all P<0.001). 63.0% patients' 24-hour IOP fluctuation was greater than or equal to 8 mmHg (51.4% in group A, 75.0% in group B). 49.3% patients' clinical management was changed based on the result of self-monitoring 24-hour IOP, and the changing proportion in group B (63.9%) was higher than that in group A (35.1%) (χ2 =6.035, P=0.014). Conclusions: Self-measurement of 24-hour IOP in POAG patients with medical treatment would identify IOP peaks and fluctuations missed in routine clinical practice, which can be used as an important evidence for clinician to evaluate therapeutic effects and adjust clinical management.