RESUMO
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.
Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Ritmo Circadiano , Síndrome de Exfoliação/tratamento farmacológico , Glaucoma de Ângulo Aberto/tratamento farmacológico , Timolol/uso terapêutico , Idoso , Síndrome de Exfoliação/fisiopatologia , Feminino , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Pressão Intraocular/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
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.
Assuntos
Agonistas alfa-Adrenérgicos/uso terapêutico , Antagonistas Adrenérgicos beta/uso terapêutico , Clonidina/análogos & derivados , Síndrome de Exfoliação/tratamento farmacológico , Glaucoma de Ângulo Aberto/tratamento farmacológico , Timolol/uso terapêutico , Agonistas alfa-Adrenérgicos/efeitos adversos , Antagonistas Adrenérgicos beta/efeitos adversos , Idoso , Ritmo Circadiano , Clonidina/efeitos adversos , Clonidina/uso terapêutico , Quimioterapia Combinada , Síndrome de Exfoliação/fisiopatologia , Feminino , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Pressão Intraocular/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Timolol/efeitos adversosRESUMO
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.
Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Ritmo Circadiano/fisiologia , Síndrome de Exfoliação/complicações , Glaucoma de Ângulo Aberto/fisiopatologia , Pressão Intraocular/fisiologia , Timolol/uso terapêutico , Idoso , Ritmo Circadiano/efeitos dos fármacos , Feminino , Glaucoma de Ângulo Aberto/tratamento farmacológico , Glaucoma de Ângulo Aberto/etiologia , Humanos , Pressão Intraocular/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Soluções Oftálmicas , Estudos ProspectivosRESUMO
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.