Abstract Intraocular pressure (IOP) reduction continues to be the mainstay of glaucoma treatment. IOP fluctuations increase the risk of progression. In patients with well controlled office hours IOPs, very few studies have compared the effectiveness of surgical versus medical management in controlling the peaks and fluctuations in IOP. This prospective case series compared the 24 hour IOP fluctuations and IOP profiles in 10 patients with well controlled open angle glaucoma (OAG), in whom one eye was managed medically and the other had undergone surgery. 24 hour phased IOP measurements (10 AM, 2 PM, 6 PM, 10 PM, 2 AM, 6 AM) were recorded by Goldmann Applanation Tonometry (GAT) and Tonopen. Mean and peak IOPs, IOP fluctuation and 24 hour curves were compared. The 24 hour mean GAT IOP was 15.78 ± 1.43 mmHg in the medical group and 12.85 ± 1.97 mmHg in the surgical group. The peak IOPs were 18.90 ± 1.10 mmHg and 15.10 ± 2.18 mmHg in the medical and surgical groups respectively. 24 hour fluctuation was 4.20 ± 1.47 mmHg in the surgical group compared to 6.20 ± 1.47 mmHg the medical group. Surgical group showed no peaks whereas an early morning peak was seen in the medical group. Mean nocturnal IOP (mean of 2 AM and 6 AM IOPs) in supine position was lower in the surgical group as compared to the medical group (Tonopen 11.65 ± 1.83 vs 14.96 ± 2.87 mmHg; GAT 13.05 ± 2.46 vs 16.35 ± 2.65 mmHg respectively). Thus,in this case series, we found that in OAG patients with well controlled IOPs, the surgical group showed lower 24 hour IOP fluctuation, as well as lower mean and peak IOPs. The early morning peak in IOP was seen only in the medical group.
Jeevakumari et al. (Thu,) studied this question.