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Effect of Timolol on the Diurnal Intraocular Pressure in Exfoliation and Primary Open-angle Glaucoma

Effect of Timolol on the Diurnal Intraocular Pressure in 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) who were treated with a solution of timolol maleate (0.5%) twice daily. Design: Consecutive Greek patients who were newly diagnosed as having EXG or POAG were prospectively investigated; they underwent 24-hour diurnal IOP measurements first without therapy and then 6 months afterward while they were being treated with timolol maleate (0.5%). After matching for age, 38 pairs of patients with these 2 types of glaucoma were compared. Results: Untreated patients with EXG had significantly higher IOP values for all time points assessed and a greater mean range of IOPs (11.8 mm Hg for EXG vs 7.6 mm Hg for POAG; P≤.001 ). Following therapy with timolol maleate (0.5%) given twice daily, patients with EXG had higher IOP values for the measurements that were obtained at 6 and 10 am, 10 pm, and 2 am, a higher mean range of IOPs (7.0 mm Hg for EXG vs 5.6 mm Hg for POAG; P=.03), and a higher maximum IOP (mean, 24.9 mm Hg for EXG vs 20.9 mm Hg for POAG; P=.003). The reduction of the range of diurnal variation of IOP was more pronounced in patients with EXG than in patients with POAG (40% vs 26%; P=.04). Twenty-two (58%) of 38 patients with EXG and 20 (53%) of 38 patients with POAG had peak IOP values that were found outside office hours. Only 5 (13%) of the patients with EXG exhibited an IOP of 18 mm Hg or less at all time points compared with 12 (32%) of the patients with POAG (P=.05). Conclusion: Despite a greater initial IOP reduction in the patients with EXG treated with timolol, a higher IOP and significant fluctuation in the diurnal curve of IOP during the time in which patients received therapy still characterized EXG from POAG. References 1. Ritch R. Exfoliation syndrome and occludable angles . Trans Am Ophthalmol Soc . 1994;92:845-944. 2. Konstas AGP, Jay JL, Marshall GE, Lee WR. Prevalence, diagnostic features and response to trabeculectomy in exfoliation glaucoma . Ophthalmology . 1993;100:619-627.Crossref 3. Konstas AGP, Dimitracoulias N, Konstas PA. Exfoliation syndrome and open angle glaucoma . Klin Monatsbl Augenheilkd . 1993;202:259-268.Crossref 4. Ritch R. Exfoliation syndrome: the most common identifiable cause of open-angle glaucoma . J Glaucoma . 1994;3:176-178. 5. Thorburn W. The outcome of visual function in capsular glaucoma . Acta Ophthalmol . 1988;184( (suppl) ):132-137. 6. Jerndal T. Open angle glaucoma and the pseudo-exfoliation syndrome . In: Cairns JE, ed. Glaucoma . New York, NY: Grune & Stratton Inc; 1986:661-677. 7. Lindblom B, Thorburn W. Functional dAMage at diagnosis of primary open angle glaucoma . Acta Ophthalmol . 1984;62:223-229.Crossref 8. Pohjanpelto P. Long term prognosis of visual field in glaucoma simplex and glaucoma capsulare . Acta Ophthalmol . 1985;63:418-423.Crossref 9. Konstas AGP, Stewart WC, Stroman GA, Sine CS. Comparison in the clinical presentation and initial treatment response of glaucoma in patients with exfoliation versus chronic open-angle glaucoma . Ophthalmic Surg Lasers . 1997;28:111-117. 10. Tarkkanen A. Treatment of chronic open-angle glaucoma associated with pseudoexfoliation . Ada Ophthalmol . 1965;43:514-523. 11. Konstas AGP. Morphological and Clinical Studies on the Exfoliation Syndrome and Open Angle Glaucoma. Glasgow, Scotland: University of Glascow; 1993:1-364. Thesis. 12. Konstas AGP, Mantziris DA, Stewart WC. Diurnal intraocular pressure in untreated exfoliation and primary open angle glaucoma . Arch Ophthalmol . 1997;115:182-185.Crossref 13. Airaksinen PJ. The long term hypotensive effect of timolol maleate compared with the effect of pilocarpine in simple and capsular glaucoma . Acta Ophthalmol . 1979;57:425-434.Crossref 14. Aasved H, Seland JH, Slagsvold JE. Timolol maleate in the treatment of open angle glaucoma . Acta Ophthalmol . 1979;57:700-708.Crossref 15. Blika S, Saunte E. Timolol maleate in the treatment of glaucoma simplex and glaucoma capsulare . Acta Ophthalmol . 1982;60:967-976.Crossref 16. 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 17. 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 18. 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. 19. Drance SM. The significance of the diurnal tension variations in normal and glaucomatous eyes . Arch Ophthalmol . 1960;64:494-501.Crossref 20. Horie T, Kitazawa Y. The clinical significance of diurnal pressure variation in primary open-angle glaucoma . Jpn J Ophthalmol . 1979;23:310-333. 21. Katavisto M. The diurnal variations of ocular tension in glaucoma . Acta Ophthalmol . 1964;78( (suppl) ):1-131. 22. Langley D, Swanljung H. Ocular tension in glaucoma simplex . Br J Ophthalmol . 1952;35:445-458.Crossref 23. Kitazawa Y, Horie T. Diurnal variations of intraocular pressure in primary open angle glaucoma . Am J Ophthalmol . 1975;79:557-566. 24. Wilensky J. Diurnal variations in intraocular pressure . Trans Am Ophthalmol Soc . 1991;89:757-790. 25. Wilensky JT, Gieser DK, Dietsche ML, Mori MT, Zeimer R. Individual variability in the diurnal intraocular pressure curve . Ophthalmology . 1993;100:940-944.Crossref 26. Tarkkanen AH. Pseudoexfoliation of the lens capsule . Acta Ophthalmol . 1962;71( (suppl) ):9-98. 27. Ringvold A. Exfoliation glaucoma . Ophthalmologica . 1994;6:403-409. 28. Konstas AG, Allan D. Pseudoexfoliation glaucoma in Greece . Eye . 1989;3:747-753.Crossref 29. Olivius E, Thorburn W. Prognosis of glaucoma simplex and glaucoma capsulare: a comparative study . Acta Ophthalmol . 1978;56:921-934.Crossref 30. Psilas K, Prevezas D, Petroutsos G, Kitsos G, Katsougiannopoulos V. Comparative study of argon laser trabeculoplasty in primary open-angle and pseudoexfoliation glaucoma . Ophthalmologica . 1989;198:57-63.Crossref 31. Weber J, Koll W, Krieglstein G. Intraocular pressure and visual decay in chronic glaucoma . Ger J Ophthalmol . 1993;2:165-169. 32. 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. 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. O'Brien C, Schwartz B, TakAMoto T, Wu DC. Intraocular pressure and the rate of visual field loss in chronic open-angle glaucoma . Am J Ophthalmol . 1991;111:491-500. 35. 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. 36. Reynolds PM, Crick RP. Diurnal curves during topical timolol therapy: a oneyear study . Glaucoma . 1982;4:262-266. 37. Reynolds PM. The effect of topical timolol maleate on the diurnal curve—a preliminary report . Res Clin Forum . 1980;2:183-187. 38. David R, Sachs U. Long-term follow-up of patients with various types of glaucoma and ocular hypertension . Glaucoma . 1981;3:323-325. 39. Silverstone DE, Arkfield D, Cowan D, Lue JC, Novack GD. Long term diurnal control of intra-ocular pressure with levobunolol and timolol . Glaucoma . 1985;7:138-140. 40. Martin X, Rabineau PA. Modification de l'AMplitude des variations nychtemerales de la pression intra-oculaire sous timolol . J Fr Ophtalmol . 1988;11/12:843-848. 41. 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 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

Effect of Timolol on the Diurnal Intraocular Pressure in 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.1997.01100160145002
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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) who were treated with a solution of timolol maleate (0.5%) twice daily. Design: Consecutive Greek patients who were newly diagnosed as having EXG or POAG were prospectively investigated; they underwent 24-hour diurnal IOP measurements first without therapy and then 6 months afterward while they were being treated with timolol maleate (0.5%). After matching for age, 38 pairs of patients with these 2 types of glaucoma were compared. Results: Untreated patients with EXG had significantly higher IOP values for all time points assessed and a greater mean range of IOPs (11.8 mm Hg for EXG vs 7.6 mm Hg for POAG; P≤.001 ). Following therapy with timolol maleate (0.5%) given twice daily, patients with EXG had higher IOP values for the measurements that were obtained at 6 and 10 am, 10 pm, and 2 am, a higher mean range of IOPs (7.0 mm Hg for EXG vs 5.6 mm Hg for POAG; P=.03), and a higher maximum IOP (mean, 24.9 mm Hg for EXG vs 20.9 mm Hg for POAG; P=.003). The reduction of the range of diurnal variation of IOP was more pronounced in patients with EXG than in patients with POAG (40% vs 26%; P=.04). Twenty-two (58%) of 38 patients with EXG and 20 (53%) of 38 patients with POAG had peak IOP values that were found outside office hours. Only 5 (13%) of the patients with EXG exhibited an IOP of 18 mm Hg or less at all time points compared with 12 (32%) of the patients with POAG (P=.05). Conclusion: Despite a greater initial IOP reduction in the patients with EXG treated with timolol, a higher IOP and significant fluctuation in the diurnal curve of IOP during the time in which patients received therapy still characterized EXG from POAG. References 1. Ritch R. Exfoliation syndrome and occludable angles . Trans Am Ophthalmol Soc . 1994;92:845-944. 2. Konstas AGP, Jay JL, Marshall GE, Lee WR. Prevalence, diagnostic features and response to trabeculectomy in exfoliation glaucoma . Ophthalmology . 1993;100:619-627.Crossref 3. Konstas AGP, Dimitracoulias N, Konstas PA. Exfoliation syndrome and open angle glaucoma . Klin Monatsbl Augenheilkd . 1993;202:259-268.Crossref 4. Ritch R. Exfoliation syndrome: the most common identifiable cause of open-angle glaucoma . J Glaucoma . 1994;3:176-178. 5. Thorburn W. The outcome of visual function in capsular glaucoma . Acta Ophthalmol . 1988;184( (suppl) ):132-137. 6. Jerndal T. Open angle glaucoma and the pseudo-exfoliation syndrome . In: Cairns JE, ed. Glaucoma . New York, NY: Grune & Stratton Inc; 1986:661-677. 7. Lindblom B, Thorburn W. Functional dAMage at diagnosis of primary open angle glaucoma . Acta Ophthalmol . 1984;62:223-229.Crossref 8. Pohjanpelto P. Long term prognosis of visual field in glaucoma simplex and glaucoma capsulare . Acta Ophthalmol . 1985;63:418-423.Crossref 9. Konstas AGP, Stewart WC, Stroman GA, Sine CS. Comparison in the clinical presentation and initial treatment response of glaucoma in patients with exfoliation versus chronic open-angle glaucoma . Ophthalmic Surg Lasers . 1997;28:111-117. 10. Tarkkanen A. Treatment of chronic open-angle glaucoma associated with pseudoexfoliation . Ada Ophthalmol . 1965;43:514-523. 11. Konstas AGP. Morphological and Clinical Studies on the Exfoliation Syndrome and Open Angle Glaucoma. Glasgow, Scotland: University of Glascow; 1993:1-364. Thesis. 12. Konstas AGP, Mantziris DA, Stewart WC. Diurnal intraocular pressure in untreated exfoliation and primary open angle glaucoma . Arch Ophthalmol . 1997;115:182-185.Crossref 13. Airaksinen PJ. The long term hypotensive effect of timolol maleate compared with the effect of pilocarpine in simple and capsular glaucoma . Acta Ophthalmol . 1979;57:425-434.Crossref 14. Aasved H, Seland JH, Slagsvold JE. Timolol maleate in the treatment of open angle glaucoma . Acta Ophthalmol . 1979;57:700-708.Crossref 15. Blika S, Saunte E. Timolol maleate in the treatment of glaucoma simplex and glaucoma capsulare . Acta Ophthalmol . 1982;60:967-976.Crossref 16. 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 17. 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 18. 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. 19. Drance SM. The significance of the diurnal tension variations in normal and glaucomatous eyes . Arch Ophthalmol . 1960;64:494-501.Crossref 20. Horie T, Kitazawa Y. The clinical significance of diurnal pressure variation in primary open-angle glaucoma . Jpn J Ophthalmol . 1979;23:310-333. 21. Katavisto M. The diurnal variations of ocular tension in glaucoma . Acta Ophthalmol . 1964;78( (suppl) ):1-131. 22. Langley D, Swanljung H. Ocular tension in glaucoma simplex . Br J Ophthalmol . 1952;35:445-458.Crossref 23. Kitazawa Y, Horie T. Diurnal variations of intraocular pressure in primary open angle glaucoma . Am J Ophthalmol . 1975;79:557-566. 24. Wilensky J. Diurnal variations in intraocular pressure . Trans Am Ophthalmol Soc . 1991;89:757-790. 25. Wilensky JT, Gieser DK, Dietsche ML, Mori MT, Zeimer R. Individual variability in the diurnal intraocular pressure curve . Ophthalmology . 1993;100:940-944.Crossref 26. Tarkkanen AH. Pseudoexfoliation of the lens capsule . Acta Ophthalmol . 1962;71( (suppl) ):9-98. 27. Ringvold A. Exfoliation glaucoma . Ophthalmologica . 1994;6:403-409. 28. Konstas AG, Allan D. Pseudoexfoliation glaucoma in Greece . Eye . 1989;3:747-753.Crossref 29. Olivius E, Thorburn W. Prognosis of glaucoma simplex and glaucoma capsulare: a comparative study . Acta Ophthalmol . 1978;56:921-934.Crossref 30. Psilas K, Prevezas D, Petroutsos G, Kitsos G, Katsougiannopoulos V. Comparative study of argon laser trabeculoplasty in primary open-angle and pseudoexfoliation glaucoma . Ophthalmologica . 1989;198:57-63.Crossref 31. Weber J, Koll W, Krieglstein G. Intraocular pressure and visual decay in chronic glaucoma . Ger J Ophthalmol . 1993;2:165-169. 32. 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. 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. O'Brien C, Schwartz B, TakAMoto T, Wu DC. Intraocular pressure and the rate of visual field loss in chronic open-angle glaucoma . Am J Ophthalmol . 1991;111:491-500. 35. 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. 36. Reynolds PM, Crick RP. Diurnal curves during topical timolol therapy: a oneyear study . Glaucoma . 1982;4:262-266. 37. Reynolds PM. The effect of topical timolol maleate on the diurnal curve—a preliminary report . Res Clin Forum . 1980;2:183-187. 38. David R, Sachs U. Long-term follow-up of patients with various types of glaucoma and ocular hypertension . Glaucoma . 1981;3:323-325. 39. Silverstone DE, Arkfield D, Cowan D, Lue JC, Novack GD. Long term diurnal control of intra-ocular pressure with levobunolol and timolol . Glaucoma . 1985;7:138-140. 40. Martin X, Rabineau PA. Modification de l'AMplitude des variations nychtemerales de la pression intra-oculaire sous timolol . J Fr Ophtalmol . 1988;11/12:843-848. 41. 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

Journal

Archives of OphthalmologyAmerican Medical Association

Published: Aug 1, 1997

References