Simultaneous 24-hour monitoring of intraocular pressure and arterial blood pressure in patients with progressive and non-progressive primary open-angle glaucoma.

We measured and compared diurnal and nocturnal blood pressure (BP) with the Space Labs Holter in progressive and non-progressive glaucomatous patients with a satisfactory diurnal control of IOP in order to identify any link between a progressive worsening of their visual field (VF) defects and the characteristics of their nocturnal BP "dip". Ambulatory 24-hour BP monitoring and inpatient IOP curves were done on two consecutive days on 36 patients (17 women, 19 men, mean age 67.44 +/- 8.06 years) with moderate to severe POAG and good diurnal therapeutic control of IOP (daytime IOP < or = 21 mm Hg). Depending on the stability or progression of their VF defects during the last two years, the patients were classified in two groups: the progressive group comprised 24 patients (14 women, 10 men) and the stable group 12 patients (9 men, 3 women). We compared local and systemic risk factors for POAG, mean and maximum daytime and nighttime IOP in each group. The mean systolic and diastolic daytime BP, mean systolic and diastolic nighttime BP and the nocturnal systolic and diastolic BP dip were calculated for each patient. The distribution of these parameters was then statistically compared with normal reference values and for the two groups. The groups were closely comparable as regards their IOP 24-hour profile. The overall mean daytime, nighttime, and nocturnal dips fell within the normal range of the reference population. We found a significanty smaller systolic and diastolic BP dip in the progressive group and a broader distribution of the lower values both for systolic and diastolyc BP in the progressive group. A broader distribution of the lower values for systolic and diastolic BP dip was also noticed when progressive patients were compared with the reference population. The relative absence of a nocturnal BP dip may be interpreted as another disturbing factor in the self-regulatory mechanisms of the optic nerve head in glaucoma.

[Combined operations: trabeculectomy, crystalline lens extraction and insertion of a posterior chamber implant: a 3-year retrospective study]. / Opérations combinées: trabéculectomie, extraction du cristallin et mise en place d'un implant de chambre postérieure: etude rétrospective sur 3 ans.

Thirty-four eyes of 29 patients with coexisting cataract and glaucoma that underwent glaucoma triple procedure between 1991 et 1994 were retrospectively analyzed. Mean follow-up was 9 months. A phacotrabeculectomy (PHACO-TRAB) was performed in 21 eyes, 13 eyes received extracapsular cataract extraction with trabculectomy (ECCE-TRAB). In 26 eyes, adjunctive 5-FluoroUracil subconjunctival injections were administrated. Our results showed a mean decrease from preoperative intraocular pressure (IOP) baseline of 10.5 mmHg at 3 months. (Mean preoperative IOP = 25.6 mmHg, mean IOP 3 months = 15.1 mmHg). The mean IOP decrease appears equivalent in the PHACOTRAB group compared to the ECCE-TRAB group, with a stable IOP result during the follow-up. Overall mean visual acuity improved from 0.16 preoperatively to 0.6 at 3 months with a slightly better result in the PHACO-TRAB group. Postoperative hyphema and fibrinous anterior uveitis were seen more often in the ECCE-TRAB than in the PHACO-TRAB group. This observation, along with the rapidity of the surgery, the quicker visual rehabilitation and the technique that is less disruptive to the conjunctiva are arguments in favour of phacotrabeculectomy whenever a combined procedure is indicated.