Comparison of 24 hour control with Timoptic 0.5% and Timoptic-XE 0.5% in exfoliation and primary open-angle glaucoma.

PURPOSE: To compare the 24 hour intraocular pressure (IOP) curve in exfoliation glaucoma (EXG) and primary open-angle glaucoma (POAG) patients treated first with timolol solution 0.5% (TS) twice daily and then with timolol maleate gel forming solution 0.5% (TXE) once daily. METHODS: We prospectively investigated age-matched, newly diagnosed EXG (n = 25) and POAG (n = 25) patients who were admitted as in-patients for 24 hour phasing first with TS and then TXE. RESULTS: Generally TS and TXE controlled both POAG and EXG patients in a similar fashion. However, a trend to lower pressures was observed in both EXG and POAG patients with TS therapy. At two time points (10:00 and 22:00) in POAG patients, TS (18.4 +/- 3.7 and 17.2 +/- 3.1 mm Hg, respectively) provided lower intraocular pressures than TXE (19.8 +/- 3.5 and 18.9 +/- 3.8 mm Hg, respectively) (p < 0.05). CONCLUSION: Both TS twice daily and TXE once daily control POAG and EXG generally to a similar extent.

The comparative ocular hypotensive effect of apraclonidine with timolol maleate in exfoliation versus primary open-angle glaucoma patients.

PURPOSE: To compare the effect of adding apraclonidine 0.5% to timolol maleate 0.5% in patients with exfoliation versus primary open-angle glaucoma. Since exfoliation glaucoma is known to demonstrate higher pressures than primary open-angle glaucoma on timolol maleate therapy alone, the authors wished to determine whether apraclonidine equalised the intraocular pressure (IOP) between these two glaucomas when added to timolol maleate. METHODS: We age-matched 30 consecutive exfoliation and 30 primary open-angle glaucoma patients who had an IOP > or = 22 mmHg on timolol maleate alone. Patients underwent IOP diurnal curve testing on timolol maleate twice daily alone and, 2 months later, following the addition of apraclonidine 0.5% three times daily. Statistical analysis of the IOP at each time point was by an unpaired t-test between groups. A paired t-test was used to evaluate the reduction in IOP from baseline within groups after the addition of apraclonidine. RESULTS: On timolol maleate alone, exfoliation patients had a higher mean IOP at 06:00 and 10:00 hours as well as a higher peak, range and standard deviation of the IOP compared with primary open-angle glaucoma patients (p < 0.05). Following the addition of apraclonidine the mean, peak and range of IOP were statistically similar between groups and only the standard deviations remained higher in the exfoliation glaucoma group (p < 0.001). The mean diurnal IOP after apraclonidine was added was 20.5 +/- 7.0 mmHg in the exfoliation glaucoma group and 20.0 +/- 3.4 mmHg in the primary open-angle glaucoma group, which was not significantly different between groups (p = 0.73). CONCLUSIONS: This study suggests that apraclonidine 0.5% used adjunctively with timolol maleate 0.5% solution is associated generally with similar IOP control in exfoliation and primary open-angle glaucoma patients.

Effect of timolol on the diurnal intraocular pressure in exfoliation and primary open-angle glaucoma.

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 < or = .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.

Diurnal intraocular pressure in untreated exfoliation and primary open-angle glaucoma.

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.