日间与昼夜眼压曲线对异常眼压测量能力的比较

目的评价日间眼压曲线与昼夜眼压曲线对异常眼压测量的能力。方法对就诊于北京同仁眼科中心的21例原发性开角型青光眼（POAG）、11例可疑正常眼压性青光眼（SNTG）及24例可疑青光眼患者进行昼夜眼压曲线测量。间隔2 h后,先使用手持式压平眼压计测量24 h的卧位眼压得到昼夜卧位眼压曲线。在9：30、11：30、13：30、15：30,患者完成卧位眼压测量5 min后测量坐位眼压,5 min后再使用非接触眼压计测量眼压,分别得到日间卧位眼压曲线、日间坐位眼压曲线和日间非接触眼压曲线。定义眼压峰值〉21 mmHg时为峰值异常,眼压波动〉5 mmHg时为波动异常。分析日间眼压曲线与昼夜眼压曲线均值、峰值及波动值间是否存在差异。结果不同组别昼夜眼压均值为（20.24±2.45）～（22.32±6.02）mmHg,较日间眼压均值高-0.19～6.37 mmHg;昼夜眼压峰值在（24.17±3.42）～（26.43±6.23）mmHg,较日间眼压峰值高1.75～8.76 mmHg;昼夜眼压波动在（8.00±3.47）～（9.09±3.83）mmHg,较日间眼压波动高3.59～6.00 mmHg。眼压峰值多出现于夜间睡眠时,POAG、SNTG和可疑青光眼患者眼压峰值出现于23：30～5：30的概率分别为57.14%、72.73%和66.67%。日间眼压曲线无法确定昼夜眼压波动的异常,若以昼夜眼压曲线作为金标准,各组的敏感性为10.00%～36.84%。结论56例患者的峰值眼压多发生在夜间睡眠时,日间和昼夜眼压曲线测得的眼压均值、峰值、波动及发现异常眼压的能力存在差异,依靠日间眼压曲线很难对昼夜眼压的情况做出准确判断。

Comparison of ability to find abnormal IOP between diurnal and circadian IOP curve

Background To seek the regulation of diurnal intraocular pressure（IOP） fluctuate is very important for preventing the damage of optical nerve in the patient with glaucoma.The diurnal IOP curve is a key index in clinic.ObjectiveThis study is to compare the diurnal mean and peak IOP value in the patients with glaucoma and evaluate the ability of daytime IOP and diurnal IOP to reflect the abnormality of IOP.MethodsThe 24-hour IOP values were recorded in the right eyes from 21 patients with primary open angle glaucoma（POAG）,11 patients with suspect normal tension glaucoma（SNTG） and 24 patients with suspect glaucoma（SG）.The IOP values from applanation tonometer in supine were measured in two-hour interval through the 24 hours with applanation tonometer,and the sitting IOP and non-contact tonometer were recorded in 9：30,11：30,13：30 and 15：30 respectively.The abnormal peak IOP value and fluctuation IOP value was determined as 21mmHg and 5mmHg respectively.ResultsThe mean circadian IOPs were significantly different in different examination methods in POAG patients（F=6.434,P=0.001） and SG patients（F=15.719,P=0.000）.The daytime non-contact IOP value was significantly lower than the diurnal supine IOP value in POAG and SG patients（P0.05）.The mean circadian peak IOP values in daytime non-contact and daytime sitting IOP value were considerably declined in comparison with diurnal supine IOP value in POAG and SG patients（P0.01）.The mean circadian IOP fluctuation values were markedly lower in daytime supine IOP value,daytime non-contact and daytime sitting IOP value in comparison with diurnal supine IOP value in all of the three types of glaucoma groups（P0.01）.The peak IOP occurred during the sleep duration in the majority of the patients with the probability ratio 57.14%,72.73% and 66.67% in POAG,SNTG and SG patients separately.The sensitivity of diurnal IOP curve to abnormal IOP circadian fluctuation was from 10.00% to 36.84% in different groups.ConclusionThis study indicates that it is unreliable for us to accurately determine the change of IOP just rely on the daytime IOP curve.Diurnal variation of IOP must be considered in the treatment of glaucoma.