A.Rahim @ Samsuddin, Haslinda
(2015)
The effect of 24-hour intraocular pressure fluctuation
on glaucoma progression in primary angle closure glaucoma.
Masters thesis, Universiti Sains Malaysia.
Abstract
Introduction
Primary Angle Closure Glaucoma (PACG) is a common glaucoma type in Asian
population. Malays are among affected races in South East Asian with PACG
prevalence of 0.12% to 2.5%. To date, intraocular pressure (IOP) is the only
modifiable glaucoma risk factor. Two IOP subcomponents; the higher mean IOP and
the wider IOP fluctuations are currently being looked upon as important predictors of
glaucoma progression.
Objectives
To determine and compare the 24-hour overall mean IOP, mean IOP peak, mean IOP
trough, and IOP fluctuation in progressed and non-progressed PACG.
Methodology
A cross-sectional study was conducted in Hospital Universiti Sains Malaysia,
Kelantan involving 25 patients with 50 eyes diagnosed with PACG. They were
grouped into progressed PACG (11 eyes) and non-progressed PACG (39 eyes).
AGIS scoring system was used to determine the progression group. All patients were
admitted for 24 hours period. Six IOP measurements were performed at 4-hour time
points; at 0800, 1200, 1600, 2000, 2400, and 0400. Goldmann Applanation
Tonometer (GAT) was used for all IOP measurements. Statistical analysis used were
independent t test, Mann-Whitney U test, and Fisher’s exact test.
Results
Majority of progressed eye group of PACG exhibited patterns of night peak with
afternoon trough, while non-progressed eye group showed patterns of morning peak
with night trough. At 4-hour time points, the progressed eye group had lower mean
IOP, mean peak IOP, and mean trough IOP but wider mean IOP fluctuation. Over
24 hour period, there was no significant difference for all IOP variables in both
groups. The 24-hour mean overall IOP mean range was 13.7 to 15.3 mmHg (p =
0.202), overall mean IOP peak range was 17.0 to 18.0 mmHg (p = 0.285), overall
mean trough range was 11.0 to 13.0 mmHg (p = 0.151), and overall mean IOP
fluctuation was 6.0 mmHg (p = 0.803).
Conclusion
Progressed and non-progressed eye group of PACG demonstrated no significant
difference in terms of all IOP variables over 24-hour period. Despite similar overall
mean IOP fluctuation during 24-hour period, the progressed eye group had wider
mean IOP fluctuation than the non-progressed eye group at 4-hour time points.
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