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Diurnal Intraocular Pressure in Untreated Exfoliation and Primary Open-angle Glaucoma

Diurnal Intraocular Pressure in Untreated Exfoliation and Primary Open-angle Glaucoma Abstract Objective: To describe and compare the diurnal intraocular pressure (IOP) variation in patients with exfoliation glaucoma (EXG) and primary open-angle glaucoma (POAG). Patients and Design: We prospectively investigated consecutive Greek patients with newly diagnosed untreated EXG and POAG. All patients were admitted to our ophthalmology department for 24-hour IOP measurements according to a standard protocol. After matching for age, we compared 40 pairs of patients with these 2 glaucomas. Results: Patients with EXG showed a significantly higher mean range of IOP (13.5 vs 8.5 mm Hg for POAG; unpaired t test, P<.001), higher maximum IOP (mean, 38.2 vs 26.9 mm Hg for POAG; unpaired t test, P<.001), and higher minimum IOP (mean, 24.7 vs 18.4 mm Hg for POAG; unpaired t test, P<.001). Patients with EXG more often demonstrated an IOP range higher than 15 mm Hg (35% vs only 7.5% for POAG). Importantly, in 45% of patients with EXG and 22.5% of patients with POAG, the peak level of IOP was found outside office hours. There was no significant difference in visual function (visual acuity, cupping, visual field) at diagnosis between the 2 glaucoma groups. Conclusion: Significant fluctuation in the diurnal curve of the IOP distinguishes EXG from POAG and may be an important factor in predicting any subsequent poor response to medical therapy. References 1. Ritch R. Exfoliation syndrome: the most common identifiable cause of open-angle glaucoma . J Glaucoma . 1994;3:176-178. 2. Konstas AGP, Dimitracoulias N, Konstas PA. Exfoliation syndrome and open angle glaucoma . Klin Monatsbl Augenheilkd . 1993;202:259-268.Crossref 3. Kozart DM, Yanoff M. Intraocular pressure status in 100 consecutive patients with exfoliation syndrome . Ophthalmology . 1982;89:214-218.Crossref 4. Slagsvold JE. The follow-up in patients with pseudoexfoliation of the lens capsule with and without glaucoma, 2: the development of glaucoma in persons with pseudoexfoliation . Acta Ophthalmol . 1986;58:188-191.Crossref 5. Konstas AGP, Jay JL, Marshall GE, Lee WR. Prevalence, diagnostic features and response to trabeculectomy in exfoliation glaucoma . Ophthalmology . 1993;100:619-627.Crossref 6. Henry JC, Krupin T, Schmitt M, et al. Long-term follow-up of pseudoexfoliation and the development of elevated intraocular pressure . Ophthalmology . 1987;94:545-552.Crossref 7. Ringvold A. Exfoliation glaucoma . Ophthalmologia . 1994;6:403-409. 8. Ringvold A, Blika S, Elsas T, et al. The Middle-Norway eye screening study, I: epidemiology of pseudo-exfoliation syndrome . Acta Ophthalmol . 1988;66:652-658.Crossref 9. Konstas AG, Allan D. Pseudoexfoliation glaucoma in Greece . Eye . 1989;3:747-753.Crossref 10. Forsius H. Exfoliation syndrome in various ethnic populations . Acta Ophthalmol . 1988;184( (suppl) ):71-85. 11. Stefaniotou M, Petroutsos G, Psilas K. The frequency of pseudoexfoliation in a region of Greece (Epirus) . Acta Ophthalmol . 1990;68:307-309.Crossref 12. Montanes JM, Serna AA, Paredes AA. Pseudoexfoliative glaucoma in patients with open-angle glaucoma in the northwest of Spain . Acta Ophthalmol . 1990;68:695-699.Crossref 13. Lindblom B, Thorburn W. Observed incidence of glaucoma in Halsingland, Sweden . Acta Ophthalmol . 1984;62:217-222.Crossref 14. Thorburn W. The outcome of visual function in capsular glaucoma . Acta Ophthalmol . 1988;184( (suppl) ):132-137. 15. Layden WE. Exfoliation syndrome . In: Ritch R, Shields MB, Krupin T, eds. The Glaucomas . St Louis, Mo: CV Mosby Co; 1989:997-1016. 16. Jerndal T. Open angle glaucoma and the pseudo-exfoliation syndrome . In: Cairns JE, ed. Glaucoma . London, England: Grune & Stratton; 1986:661-677 17. Lindblom B, Thorburn W. Functional damage at diagnosis of primary open angle glaucoma . Acta Ophthalmol . 1984;62:223-229.Crossref 18. Pohjanpelto P. Long term prognosis of visual field in glaucoma simplex and glaucoma capsulare . Acta Ophthalmol . 1985;63:418-423.Crossref 19. Tarkkanen A. Treatment of chronic open-angle glaucoma associated with pseudoexfoliation . Acta Ophthalmol . 1965;43:514-523.Crossref 20. Sugar HS. Pigmentary glaucoma and the glaucoma associated with the exfoliation syndrome: update . Ophthalmology . 1984;94:307-310.Crossref 21. Tarkkanen AH. Pseudoexfoliation of the lens capsule . Acta Ophthalmol . 1962;71( (suppl) ):9-98. 22. Konstas AGP. Morphological and Clinical Studies on the Exfoliation Syndrome and Open Angle Glaucoma. Glasgow, Scottland: University of Glasgow; 1993: 1-364. Thesis. 23. Ando K, Yamagami J, Araie M. Clinical value of measurement of daytime diurnal variation of intraocular pressure in primary open angle glaucoma . Jpn J Clin Ophthalmol . 1990;44:163-166. 24. Drance SM. The significance of the diurnal tension variations in normal and glaucomatous eyes . Arch Ophthalmol . 1960;64:494-501.Crossref 25. Horie T, Kitazawa Y. The clinical significance of diurnal pressure variation in primary open-angle glaucoma . Jpn J Ophthalmol . 1979;23:310-333. 26. Katavisto M. The diurnal variations of ocular tension in glaucoma . Acta Ophthalmol . 1964;78( (suppl) ):1-131. 27. Langley D, Swanljung H. Ocular tension in glaucoma simplex . Br J Ophthalmol . 1952;35:445-458.Crossref 28. Kitazawa Y, Horie T. Diurnal variations of intraocular pressure in primary open angle glaucoma . Am J Ophthalmol . 1975;79:557-566. 29. Wilensky J. Diurnal variations in intraocular pressure . Trans Am Ophthalmol Soc . 1991;89:757-790. 30. Wilensky JT, Gieser DK, Dietsche ML, Mori MT, Zeimer R. Individual variability in the diurnal intraocular pressure curve . Ophthalmology . 1993;100:940-944.Crossref 31. Zeimer R, Wilensky J, Gieser D. Presence and rapid decline of early morning intraocular pressure peaks in glaucoma patients . Ophthalmology . 1990;97:547-550.Crossref 32. Zeimer RC, Wilensky JT, Gieser DK, Viana MAG. Association between intraocular pressure peaks and progression of visual field loss . Ophthalmology . 1991;98:64-69.Crossref 33. Shirakashi M, Iwanta K, Sawaguchi S, Abe H, Nanba K. Intraocular pressure dependent progression of visual field loss in advanced primary open angle glaucoma: a 15-year follow up . Ophthalmologica . 1993;207:1-5.Crossref 34. David R, Zangwill L, Briscoe D, Dagan M, Yagev R, Yassur Y. Diurnal intraocular pressure variations: an analysis of 690 diurnal curves . Br J Ophthalmol . 1992;76:280-283.Crossref 35. Cordes FC. Early simple glaucoma . Arch Ophthalmol . 1937;17:896-915.Crossref 36. Duke-Elder S. The phasic variations in the intraocular tension in primary glaucoma . Am J Ophthalmol . 1952;35:1-21. 37. Stewart WC. Clinical Practice of Glaucoma . Thorofare, NJ: Slack Inc; 1990:1-40. 38. Henkind P, Walsh JB. Diurnal variations in intraocular pressure in chronic open angle glaucoma: preliminary report . Trans Ophthalmic Soc N Z . 1981;33:18-20. 39. Aihara M, Yamagami J, Araie M, Yamamoto S. Relationship of the office intraocular pressure to diurnal fluctuation of intraocular pressure in low-tension glaucoma: a multivariate analysis . Acta Soc Ophthalmol Jpn . 1992;96:1007-1013. 40. Weber J, Koll W, Krieglstein G. Intraocular pressure and visual decay in chronic glaucoma . Ger J Ophthalmol . 1993;2:165-169. 41. Mao LK, Stewart WC, Shields MB. Correlation between intraocular pressure control and progressive glaucomatous damage in primary open-angle glaucoma . Am J Ophthalmol . 1991;111:51-55. 42. Stewart WC, Chorak RP, Hunt HH, Sethuraman G. Factors associated with visual loss in patients with advanced glaucomatous changes in the optic nerve head . Am J Ophthalmol . 1993;116:176-181. 43. Shields MB. A lesson from the study of secondary glaucomas: the 14th Robert N. Shaffer Lecture . J Glaucoma . 1994;3:265-271.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

Diurnal Intraocular Pressure in Untreated Exfoliation and Primary Open-angle Glaucoma

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Publisher
American Medical Association
Copyright
Copyright © 1997 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.1997.01100150184006
Publisher site
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Abstract

Abstract Objective: To describe and compare the diurnal intraocular pressure (IOP) variation in patients with exfoliation glaucoma (EXG) and primary open-angle glaucoma (POAG). Patients and Design: We prospectively investigated consecutive Greek patients with newly diagnosed untreated EXG and POAG. All patients were admitted to our ophthalmology department for 24-hour IOP measurements according to a standard protocol. After matching for age, we compared 40 pairs of patients with these 2 glaucomas. Results: Patients with EXG showed a significantly higher mean range of IOP (13.5 vs 8.5 mm Hg for POAG; unpaired t test, P<.001), higher maximum IOP (mean, 38.2 vs 26.9 mm Hg for POAG; unpaired t test, P<.001), and higher minimum IOP (mean, 24.7 vs 18.4 mm Hg for POAG; unpaired t test, P<.001). Patients with EXG more often demonstrated an IOP range higher than 15 mm Hg (35% vs only 7.5% for POAG). Importantly, in 45% of patients with EXG and 22.5% of patients with POAG, the peak level of IOP was found outside office hours. There was no significant difference in visual function (visual acuity, cupping, visual field) at diagnosis between the 2 glaucoma groups. Conclusion: Significant fluctuation in the diurnal curve of the IOP distinguishes EXG from POAG and may be an important factor in predicting any subsequent poor response to medical therapy. References 1. Ritch R. Exfoliation syndrome: the most common identifiable cause of open-angle glaucoma . J Glaucoma . 1994;3:176-178. 2. Konstas AGP, Dimitracoulias N, Konstas PA. Exfoliation syndrome and open angle glaucoma . Klin Monatsbl Augenheilkd . 1993;202:259-268.Crossref 3. Kozart DM, Yanoff M. Intraocular pressure status in 100 consecutive patients with exfoliation syndrome . Ophthalmology . 1982;89:214-218.Crossref 4. Slagsvold JE. The follow-up in patients with pseudoexfoliation of the lens capsule with and without glaucoma, 2: the development of glaucoma in persons with pseudoexfoliation . Acta Ophthalmol . 1986;58:188-191.Crossref 5. Konstas AGP, Jay JL, Marshall GE, Lee WR. Prevalence, diagnostic features and response to trabeculectomy in exfoliation glaucoma . Ophthalmology . 1993;100:619-627.Crossref 6. Henry JC, Krupin T, Schmitt M, et al. Long-term follow-up of pseudoexfoliation and the development of elevated intraocular pressure . Ophthalmology . 1987;94:545-552.Crossref 7. Ringvold A. Exfoliation glaucoma . Ophthalmologia . 1994;6:403-409. 8. Ringvold A, Blika S, Elsas T, et al. The Middle-Norway eye screening study, I: epidemiology of pseudo-exfoliation syndrome . Acta Ophthalmol . 1988;66:652-658.Crossref 9. Konstas AG, Allan D. Pseudoexfoliation glaucoma in Greece . Eye . 1989;3:747-753.Crossref 10. Forsius H. Exfoliation syndrome in various ethnic populations . Acta Ophthalmol . 1988;184( (suppl) ):71-85. 11. Stefaniotou M, Petroutsos G, Psilas K. The frequency of pseudoexfoliation in a region of Greece (Epirus) . Acta Ophthalmol . 1990;68:307-309.Crossref 12. Montanes JM, Serna AA, Paredes AA. Pseudoexfoliative glaucoma in patients with open-angle glaucoma in the northwest of Spain . Acta Ophthalmol . 1990;68:695-699.Crossref 13. Lindblom B, Thorburn W. Observed incidence of glaucoma in Halsingland, Sweden . Acta Ophthalmol . 1984;62:217-222.Crossref 14. Thorburn W. The outcome of visual function in capsular glaucoma . Acta Ophthalmol . 1988;184( (suppl) ):132-137. 15. Layden WE. Exfoliation syndrome . In: Ritch R, Shields MB, Krupin T, eds. The Glaucomas . St Louis, Mo: CV Mosby Co; 1989:997-1016. 16. Jerndal T. Open angle glaucoma and the pseudo-exfoliation syndrome . In: Cairns JE, ed. Glaucoma . London, England: Grune & Stratton; 1986:661-677 17. Lindblom B, Thorburn W. Functional damage at diagnosis of primary open angle glaucoma . Acta Ophthalmol . 1984;62:223-229.Crossref 18. Pohjanpelto P. Long term prognosis of visual field in glaucoma simplex and glaucoma capsulare . Acta Ophthalmol . 1985;63:418-423.Crossref 19. Tarkkanen A. Treatment of chronic open-angle glaucoma associated with pseudoexfoliation . Acta Ophthalmol . 1965;43:514-523.Crossref 20. Sugar HS. Pigmentary glaucoma and the glaucoma associated with the exfoliation syndrome: update . Ophthalmology . 1984;94:307-310.Crossref 21. Tarkkanen AH. Pseudoexfoliation of the lens capsule . Acta Ophthalmol . 1962;71( (suppl) ):9-98. 22. Konstas AGP. Morphological and Clinical Studies on the Exfoliation Syndrome and Open Angle Glaucoma. Glasgow, Scottland: University of Glasgow; 1993: 1-364. Thesis. 23. Ando K, Yamagami J, Araie M. Clinical value of measurement of daytime diurnal variation of intraocular pressure in primary open angle glaucoma . Jpn J Clin Ophthalmol . 1990;44:163-166. 24. Drance SM. The significance of the diurnal tension variations in normal and glaucomatous eyes . Arch Ophthalmol . 1960;64:494-501.Crossref 25. Horie T, Kitazawa Y. The clinical significance of diurnal pressure variation in primary open-angle glaucoma . Jpn J Ophthalmol . 1979;23:310-333. 26. Katavisto M. The diurnal variations of ocular tension in glaucoma . Acta Ophthalmol . 1964;78( (suppl) ):1-131. 27. Langley D, Swanljung H. Ocular tension in glaucoma simplex . Br J Ophthalmol . 1952;35:445-458.Crossref 28. Kitazawa Y, Horie T. Diurnal variations of intraocular pressure in primary open angle glaucoma . Am J Ophthalmol . 1975;79:557-566. 29. Wilensky J. Diurnal variations in intraocular pressure . Trans Am Ophthalmol Soc . 1991;89:757-790. 30. Wilensky JT, Gieser DK, Dietsche ML, Mori MT, Zeimer R. Individual variability in the diurnal intraocular pressure curve . Ophthalmology . 1993;100:940-944.Crossref 31. Zeimer R, Wilensky J, Gieser D. Presence and rapid decline of early morning intraocular pressure peaks in glaucoma patients . Ophthalmology . 1990;97:547-550.Crossref 32. Zeimer RC, Wilensky JT, Gieser DK, Viana MAG. Association between intraocular pressure peaks and progression of visual field loss . Ophthalmology . 1991;98:64-69.Crossref 33. Shirakashi M, Iwanta K, Sawaguchi S, Abe H, Nanba K. Intraocular pressure dependent progression of visual field loss in advanced primary open angle glaucoma: a 15-year follow up . Ophthalmologica . 1993;207:1-5.Crossref 34. David R, Zangwill L, Briscoe D, Dagan M, Yagev R, Yassur Y. Diurnal intraocular pressure variations: an analysis of 690 diurnal curves . Br J Ophthalmol . 1992;76:280-283.Crossref 35. Cordes FC. Early simple glaucoma . Arch Ophthalmol . 1937;17:896-915.Crossref 36. Duke-Elder S. The phasic variations in the intraocular tension in primary glaucoma . Am J Ophthalmol . 1952;35:1-21. 37. Stewart WC. Clinical Practice of Glaucoma . Thorofare, NJ: Slack Inc; 1990:1-40. 38. Henkind P, Walsh JB. Diurnal variations in intraocular pressure in chronic open angle glaucoma: preliminary report . Trans Ophthalmic Soc N Z . 1981;33:18-20. 39. Aihara M, Yamagami J, Araie M, Yamamoto S. Relationship of the office intraocular pressure to diurnal fluctuation of intraocular pressure in low-tension glaucoma: a multivariate analysis . Acta Soc Ophthalmol Jpn . 1992;96:1007-1013. 40. Weber J, Koll W, Krieglstein G. Intraocular pressure and visual decay in chronic glaucoma . Ger J Ophthalmol . 1993;2:165-169. 41. Mao LK, Stewart WC, Shields MB. Correlation between intraocular pressure control and progressive glaucomatous damage in primary open-angle glaucoma . Am J Ophthalmol . 1991;111:51-55. 42. Stewart WC, Chorak RP, Hunt HH, Sethuraman G. Factors associated with visual loss in patients with advanced glaucomatous changes in the optic nerve head . Am J Ophthalmol . 1993;116:176-181. 43. Shields MB. A lesson from the study of secondary glaucomas: the 14th Robert N. Shaffer Lecture . J Glaucoma . 1994;3:265-271.Crossref

Journal

Archives of OphthalmologyAmerican Medical Association

Published: Feb 1, 1997

References