OCT angiographic evaluation of changes in macula and optic nerve head vessel density after a water drinking test in glaucomatous and healthy eyes.

PURPOSE: To evaluate the effects of a water drinking test (WDT) on the intraocular pressure (IOP) and vascular density of the optic nerve head and macula in healthy individuals and those with primary open glaucoma using optical coherence tomography angiography. METHODS: In this prospective comparative study, 30 healthy patients and 44 POAG subjects were divided into two groups. The study's outcome measures were the IOP and vessel density of the optic nerve and macular area. After ingesting 1000 ml of water in 5 min, the effect of the WDT on the IOP and the vascular density of the macular area and optic nerve head were measured at baseline and then 20, 40, and 60 min later at intervals of 20 min. RESULTS: The initial IOP in the healthy and glaucomatous eye groups was comparable (15.94 ± 2.6 and 16.87 ± 4.21 mmHg, respectively, P = 0.506). The IOP of both groups peaked at 40' measurements. POAG eyes had significantly higher IOP elevation (4.34 ± 0.30 vs. 2.24 ± 0.30 mmHg, P < 0.001). The glaucomatous eyes had lower radial peripapillary capillary (RPC) and whole macular superficial capillary plexus (SCP) densities at baseline (48.55 ± 5.99 vs. 51.33 ± 3.75) and (48.92 ± 3.41 vs. 45.29 ± 5.29), respectively (P < 0.001). After the WDT, the change in vessel density between groups in the RPC, whole superficial, and deep capillary plexuses was insignificant (SCP and DCP of 0.66 and 0.70, respectively, P = 0.16). CONCLUSION: The WDT caused a significant IOP jump in both glaucomatous and healthy eyes, but generally, the alterations in the glaucomatous eyes were more pronounced. The changes in vascular density in the macula and optic nerve head were similar between the groups.

In vivo quantification of human aqueous veins by enhanced depth imaging optical coherence tomography and optical coherence tomography angiography images.

AIM: To investigate the aqueous vein in vivo by using enhanced depth imaging optical coherence tomography (EDI-OCT) and optical coherence tomography angiography (OCTA). METHODS: In this cross-sectional comparative study, 30 healthy participants were enrolled. Images of the aqueous and conjunctival veins were captured by EDI-OCT and OCTA before and after water loading. The area, height, width, location depth and blood flow of the aqueous vein and conjunctival vein were measured by Image J software. RESULTS: In the static state, the area of the aqueous vein was 8166.7±3272.7 µm2, which was smaller than that of the conjunctival vein (13 690±7457 µm2, P<0.001). The mean blood flow density of the aqueous vein was 35.3%±12.6%, which was significantly less than that of the conjunctival vein (51.5%±10.6%, P<0.001). After water loading, the area of the aqueous vein decreased significantly from 8725.8±779.4 µm2 (baseline) to 7005.2±566.2 µm2 at 45min but rose to 7863.0±703.2 µm2 at 60min (P=0.032). The blood flow density of the aqueous vein decreased significantly from 41.2%±4.5% (baseline) to 35.4%±3.2% at 30min but returned to 45.6%±3.6% at 60min (P=0.021). CONCLUSION: The structure and blood flow density of the aqueous vein can be effectively evaluated by OCT and OCTA. These may become biological indicators to evaluate aqueous vein changes and aqueous outflow resistance under different interventions in glaucoma patients.

The Effect of Combined Phacoemulsification and Endo-Cyclophotocoagulation on Intraocular Pressure Fluctuation Assessed by the Water Drinking Test in Patients with Primary Open Angle Glaucoma.

INTRODUCTION: The aim of this study was to assess the effect of phacoemulsification and endo-cyclophotocoagulation (phaco-ECP) on intraocular pressure (IOP) fluctuation as assessed by the water drinking test (WDT) in primary open angle glaucoma (POAG). METHODS: This was a prospective observational study carried out at a tertiary referral centre. POAG patients on topical antiglaucoma medications and planned for phaco-ECP were recruited. WDT was performed before surgery and 6 weeks postoperatively by drinking 10 mL/kg of water in 5 min followed by serial IOP by Goldmann applanation tonometry measurements at 15, 30, 45, and 60 min. Mean IOP, IOP fluctuation (difference between highest and lowest IOP), IOP reduction, and factors affecting IOP fluctuation were analysed. RESULTS: Twenty eyes from 17 patients were included. Baseline IOP was similar before (14.7 ± 2.7 mm Hg) and after (14.8 ± 3.4 mm Hg, p = 0.90) surgery. There was no difference in mean IOP (17.6 ± 3.4 mm Hg vs. 19.3 ± 4.7 mm Hg pre- and postoperative, respectively, p = 0.26) or peak IOP (19.37 ± 3.74 mm Hg vs. 21.23 ± 5.29 mm Hg, p = 0.25), albeit a significant reduction in IOP-lowering medications (2.2 ± 1.15 vs. 0.35 ± 0.93, p < 0.001) postoperatively. IOP fluctuation was significantly greater (6.4 ± 3.2 mm Hg vs. 4.6 ± 2.1 mm Hg, p = 0.015) with more eyes having significant IOP fluctuation of ≥6 mm Hg (11 eyes [55%] vs. 4 eyes [20%], p < 0.001) postoperatively. Factors that were significantly associated with increased postoperative IOP fluctuations were higher preoperative IOP fluctuation (ß = 0.69, 95% CI 0.379-1.582, p = 0.004) and more number of postoperative antiglaucoma medications (ß = 0.627, 95% CI 0.614-3.322, p = 0.008). CONCLUSION: Reducing aqueous production with phaco-ECP does not eliminate IOP fluctuation in POAG patients. The increase in postoperative IOP fluctuation suggests increased outflow resistance after phaco-ECP.

The Effect of the Water Drinking Test on Ocular Parameters and Choroidal Thickness in Glaucoma Suspects.

Background and objectives: We aimed to evaluate the effects of the water drinking test (WDT) on several systemic and ocular parameters, including choroidal thickness, which was assessed through optical coherence tomography angiography (OCTA), in glaucoma suspects. Materials and Methods: A total of 40 eyes from 20 glaucoma suspects without any systemic or ocular diseases were included in this prospective observational study. All the participants undertook the WDT, which required the drinking of 1 L of table water in 5 min. The outcome measures included IOP, systolic and diastolic blood pressure (SBP and DBP), mean arterial pressure (MAP), mean ocular perfusion pressure (MOPP), ocular pulse amplitude (OPA), and subfoveal and peripapillary choroidal thickness, which were assessed at baseline and at four 15 min intervals after the WDT. Generalized least squares models and mixed model analyses that take into account repeated measurements were used to assess the changes over time of these parameters. Results: All the ocular and systemic parameters showed statistically significant changes at all time points compared to baseline apart from choroidal thickness. The peak changes were an IOP of 20.1 mmHg versus 17.3 mmHg at 45 min, an SBP of 137.6 mmHg versus 125 mmHg at 30 min, a DBP of 95.9 mmHg versus 85.7 mmHg at 15 min, and an MOP of 53.51 mmHg versus 48.89 mmHg at 15 min. Conclusions: Despite elevations in IOP and significant changes in all the assessed systemic parameters, the WDT was not associated with changes in choroidal thickness in glaucoma suspects.

Elevated IOP following a bladder filling protocol: A case report.

Purpose: We describe a patient with elevated intraocular pressure (IOP) secondary to an oral water bolus and examine the utility of the water-drinking test. Observations: A 66-year-old male with a history of hypertension presented with headache, bilateral retro-orbital ache, and blurry vision. Symptoms began shortly after his radiation treatment for prostate cancer, for which he consumed a water bolus to fill his bladder 30 minutes prior to treatment initiation. On exam, he had bilateral elevated IOP that responded to topical IOP-lowering medications. Gonioscopy demonstrated open angles and fundus exam showed non-glaucomatous optic nerves with pronounced retinal venous tortuosity. The water-drinking test showed a peak intraocular pressure of 20 mmHg in the right eye (5 mmHg increase from baseline) and 23 mmHg in the left eye (8 mmHg increase from baseline), suggesting impairment of the outflow system in the left compared to the right eye. He was started on topical IOP-lowering therapy and followed in our clinic as a glaucoma suspect. Conclusions: Consumption of a water bolus can be associated with IOP elevation and may be a risk factor in patients with otherwise normal IOPs at risk for glaucoma. The water-drinking test was historically used as provocative testing for open-angle glaucoma and may have an updated role in evaluating at-risk patients without ocular hypertension.

Clinical features and correlation analysis of the 24h intraocular pressure and water drinking test in patients with primary open angle glaucoma and ocular hypertension / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To summarize the clinical features of the 24h intraocular pressure data and the water drinking test(WDT)results in patients with primary open angle glaucoma(POAG)and ocular hypertension(OHT), and analyze the correlation.METHODS: To collect the data of 87 cases(174 eyes)with POAG and OHT, who had completed 24h intraocular pressure(IOP)(measured every 2h)and WDT(drink 1 000mL water off within 5min and then measure every 15min within 1h)in the ophthalmology department of Shenzhen University General Hospital from December 2019 to March 2022. They were divided into three groups, with 33 cases(66 eyes)in high tension glaucoma(HTG)group, 28 cases(56 eyes)in normal tension glaucoma(NTG)group and 26 cases(52 eyes)in OHT group. The clinical features of 24h IOP and WDT among the patients in three groups were summarized, and Spearman correlation was used to analyze the peak and fluctuation values of IOP.RESULTS: Clinical features among the patients in three groups:(1)the proportion of peak IOP of HTG, NTG and OHT group:(2:00-6:00 a.m.): 40.9%, 23.2% and 26.9%;(8:00-12:00 a.m.): 34.8%, 46.4% and 55.8%;(14:00-18:00 p.m.): 18.2%, 21.4% and 11.5%;(20:00-24:00 p.m.): 6.1%, 8.9% and 5.8%. Valley proportion among groups: early morning: 21.2%, 25.0% and 30.8%; morning: 22.7%, 10.7% and 13.5%; afternoon: 19.7%, 17.9% and 17.3%; evening: 36.4%, 46.4% and 38.5%. The proportion of 24h IOP fluctuation &#x0026;#x003C;6mmHg: 9.1%, 62.5% and 17.3%; 6-&#x0026;#x003C;8mmHg: 24.2%, 32.1% and 40.4%; ≥8mmHg: 66.7%, 5.4% and 42.3%.(2)WDT: The proportion of the three groups that could reach peak IOP within 30min was 81.8%, 76.8% and 80.8%, respectively. The proportion of IOP fluctuations in the three groups &#x0026;#x003C;6mmHg: 10.6%, 78.6% and 38.5%; 6-&#x0026;#x003C;8mmHg: 22.7%, 16.1% and 28.8%; ≥8mmHg: 66.7%, 5.4% and 32.7%.(3)the proportions of WDT peak higher than 24h peak IOP in the three groups were 80.3%, 80.4% and 80.8%. Correlation: the peak values of 24h IOP were positively correlated with the peak values of WDT(all P&#x0026;#x003C;0.01), the fluctuation of 24h IOP was positively correlated with the fluctuation of WDT in HTG and OHT group(P&#x0026;#x003C;0.01, P&#x0026;#x003C;0.05), while it showed no significant correlation in NTG group(P&#x0026;#x003E;0.05).CONCLUSION: Diurnal measurements of IOP during office hours(08:00 a.m.-18:00 p.m.)may fail to capture the peak values and underestimate IOP fluctuations. The 24h IOP fluctuation ≥HTG group of 8mmHg&#x0026;#x003E;OHT group&#x0026;#x003E;NTG group. The peak WDT in over 75% patients could be achieved within 30min, and it was higher than 24h peak IOP of over 80% patients. There was a positive correlation between the 24h IOP fluctuations and the WDT fluctuations in HTG and OHT patients. Therefore, WDT has clinical significance in assessing fluctuations in patients' IOP.

Investigation of the short-term effects of water drinking test on the eye using optical coherence tomography angiography in young healthy male subjects.

PURPOSE: To evaluate the acute effects of the water drinking test (WDT) on the eye using optical coherence tomography angiography (OCTA) on healthy young male subjects. METHODS: The study included 25 eyes of 25 male subjects. Selected parameters of the retinal vasculature were measured, including macular flow indices, foveal avascular zone, and vessel densities (VDs) of the macula using OCTA. The measurements were taken on the first day without drinking water at 0 min, 30 min and 60 min, then repeated on the second day before drinking water at 0 min, and after drinking water at 30 min and 60 min. The Paired Samples t-test and repeated measures One-way analysis of variance test were used in the statistical analyses. RESULTS: The repeated measures analysis of variance test using Bonferroni adjustment demonstrated a significant increase in superficial and deep foveal VD following WDT (p < 0.001 for both). Intraocular pressure, retinal nerve fibre layer thickness, foveal avascular zone, flow area of choriocapillaris, flow area of outer retina, foveal non-flow area of superficial layer, and retinal thickness measurements showed no significant changes following WDT. CONCLUSIONS: WDT is associated with temporary flow modifications in superficial and deep foveal vascular plexus in young male subjects.

Peak Intraocular Pressure Time during Water Drinking Test and Its Relationship with Glaucoma Severity.

PURPOSE: To investigate the association between the time of occurrence of intraocular pressure (IOP) peaks during the water-drinking test (WDT) and visual field damage in a cohort of primary open-angle glaucoma (POAG) patients. METHODS: In this retrospective, cross-sectional study, 98 eyes from 49 consecutive POAG patients were followed in a referral clinical practice. The relationship between the time when IOP peaks occurred during the WDT and the visual field mean deviation (MD) assessed with 24-2 visual field was tested with mixed-effects models. RESULTS: MD value was significantly associated with the time of IOP peak occurrence (P = 0.020) when adjusting for the number of medications, but not with the IOP peak values (P = 0.238). CONCLUSION: The time of IOP peaks occurrence during the WDT was associated with glaucoma severity among treated POAG patients.

Water-Drinking Test in Central Serous Chorioretinopathy.

PURPOSE: To evaluate choroidal changes in central serous chorioretinopathy (CSCR) patients after water-drinking test (WDT). METHODS: This prospective study included treatment-naïve acute and chronic CSCR eyes and healthy controls. Intraocular pressure and optical coherence tomography measurements with choroidal vascular index (CVI) measurements were done at baseline. Patients were asked to drink 1 L of water, and tests were repeated at 15, 30, and 45 min. RESULTS: Fifty-six eyes from 42 patients were enrolled. Choroidal area, luminal area, and stromal area were higher at baseline in eyes with acute CSCR compared to healthy controls. Chronic CSCR eyes showed an increase in choroidal area and stromal area and a decrease in the luminal area at 15 min. There was a significant decrease in CVI at 30 and 45 min in chronic CSCR and CVI at 45 min in fellow eyes of acute CSCR. Repeated-measures analysis of variance (ANOVA) showed a significant change in central macular thickness in acute CSCR, choroidal thickness in fellow eyes of acute CSCR, stromal area, and total choroidal area in chronic CSCR. Mixed model ANOVA showed that the change in various choroidal parameters seen had no interaction with the eye type. CONCLUSION: Although change in various parameters was seen in acute CSCR, chronic CSCR, and fellow eyes of acute CSCR following WDT, the change was not significantly different among the groups.

Correlation between intraocular pressure obtained with water drinking test versus modified diurnal tension curve measurement in pseudoexfoliation glaucoma.

PURPOSE: The aim of this paper was to study the correlation and agreement between the intraocular pressure (IOP) peak value and fluctuations detected with the modified diurnal tension curve (mDTC) and the water drinking test (WDT) in pseudoexfoliation glaucoma (XFG) patients. METHODS: This prospective observational study enrolled 42 eyes of 42 XFG patients. The IOPs were measured at 2-h intervals from 8 am to 4 pm with a Goldmann applanation tonometer by a single observer to establish the mDTC. The WDT was then performed between 4 and 5 pm on the same day and the IOP was measured 4 times at 15-min intervals after water ingestion. The IOPpeak, IOPmean, IO min, and IOPfluctuation were measured with both the mDTC and WDT. The paired sample t test, Spearman's correlation coefficient and Bland-Altman plots were used for statistical analysis. RESULTS: The mean age of the 42 patients consisting of 24 females and 18 males was 66.9 ± 6.8 years, and the mean central corneal thickness was 517.7 ± 29.1 µm. The mean values with the mDTC and WDT measurements were 15.05 ± 2.75 mmHg and 17.17 ± 3.25 mmHg (p ≤ 0.0001, r = 0.884) for IOPmean, 16.76 ± 3.45 mmHg and 18.92 ± 3.94 mmHg (p ≤ 0.0001, r=0.787) for IOPpeak, and 13.61 ± 2.56 mmHg and 15.11 ± 2.84 mmHg (p ≤ 0.0001, r=0.824) for IOPmin, respectively, and a positive correlation was present between these values. CONCLUSION: There was a positive correlation between the peak, minimum, and mean IOP values determined using the mDTC and WDT in treated XFG patients. WDT can be used as an alternative in the assessment of the IOP in these patients as a more practical method.

Intraocular Pressure and Corneal Biomechanical Changes after Water-Drinking Test in Glaucoma Patients.

PURPOSE: To evaluate intraocular pressure (IOP) and corneal biomechanical changes after water-drinking test (WDT) in glaucomatous and normal eyes using Ocular Response Analyzer (ORA). METHODS: This prospective study included 30 medically controlled, 30 surgically treated glaucoma patients and 30 normal individuals. Baseline measurements included central corneal thickness (CCT), ORA-derived corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated IOP (IOPcc), and Goldmann-correlated IOP (IOPg). Measurements were repeated 15, 30, and 60 min after drinking 1000 mL of water. Changes in ORA parameters were compared among the groups. RESULTS: All groups showed a significant increase in IOPg and IOPcc at all test points. Peak IOP occurred at 15 min and decreased gradually over time but did not reach the baseline values at 60 min. The surgery group had significantly lower baseline IOPg and IOPcc (10.7 ± 3.1 and 12.8 ± 3.7 mmHg, P = 0.001 and 0.01), lower peak IOPg and IOPcc (14.4 ± 4.6 and 16.2 ± 4.6 mmHg, P = 0.003 and 0.034), and lower percent IOPg and IOPcc fluctuations (13 ± 5.6 and 15 ± 5.9, P = 0.0001 and 0.002), respectively, compared to the medical group. Baseline CH and its fluctuations were not significantly different among the groups. CH decreased to a trough corresponding to peak IOPcc. There was a significant negative correlation between IOPcc and CH (r = -0.609, P < 0.001). The medical group showed more CRF fluctuations compared to normal group.(P = 0.039). CONCLUSION: Surgically treated glaucomatous eyes show less IOP fluctuations and lower peak IOP after WDT compared to medically controlled and normal eyes.

Short-Time Changes of Intraocular Pressure and Biomechanics of the Anterior Segment of the Eye during Water Drinking Test in Patients with XEN GelStent.

PURPOSE: Little is known about short-term changes in intraocular pressure (IOP) following minimally invasive glaucoma surgeries, such as post-XEN GelStent implantation. Although the importance of corneal biomechanics in glaucoma diagnostics has been reported, little work has been conducted on postoperative description of changes when the structure of the anterior segment is altered. The aim of presented study was to evaluate the changes in the biomechanical parameters of the anterior segment of the post-XEN GelStent implantation eyes. PATIENTS AND METHODS: This investigator-initiated, open-label, prospective, single-center study recruited patients. Patients with primary open-angle glaucoma (POAG) after XEN GelStent implantation versus matched POAG controls (considered as control group/CG) treated pharmacologically were screened. Water loading was conducted using 10 mL of water per kilogram of body weight for ≤5 min. Goldmann applanation tonometry (GAT), corneal hysteresis (CH), and corneal resistance factor (CRF) were performed before water loading and after every 15 min up to 1 h. RESULTS: The water drinking test (WDT) was positive in 3.7% (1 out of 27) of patients in the post-XEN group compared with 22.7% (5 out of 22) of patients in the control group (CG; p < 0.05). Mean fluctuations in GAT during the WDT were higher in the CG group (3.6 ± 2.5 mmHg vs. 2.9 ± 1.3 mmHg, p < 0.001). CRF and CH changed significantly only in the post-XEN group. The mean peak of CH and CRF occurred at 15 and 30 min of the test in the post-XEN group (p = 0.001). CONCLUSION: WDT is important to assess the ability of compensation mechanisms to reduce fluctuations in IOP after water upload. The relationship between biomechanics of the anterior segment and glaucoma may have substantial impact on surgical outcome evaluation.

Intraocular Pressure Changes after Water Drinking Test in Surgically Treated Primary Congenital Glaucoma.

PURPOSE: To assess intraocular pressure (IOP) changes after the water drinking test (WDT) in patients with primary congenital glaucoma (PCG). METHODS: In this prospective interventional study, 20 eyes of 20 patients with PCG were included. All patients had undergone trabeculotomy. Six out of twenty eyes had received a glaucoma drainage device (GDD) implantation. IOP was measured using an air-puff tonometer at baseline, and 15, 30, 45, and 60 min after WDT. The repeated-measures analysis of variance test was used to compare the mean IOPs at different time points. RESULTS: The mean ( ± standard deviation) of participants' age was 9.9 ± 2.7 years (range, 6 to 16 years), and 8 (40%) participants were male. The mean IOPs at baseline and 15, 30, 45, and 60 minutes after the WDT were 15.8 ± 3.7, 18.6 ± 3.4, 19.0 ± 3.8, 17.9 ± 3.8, and 16.9 ± 3.5 mmHg, respectively (P < 0.001). Pairwise comparisons revealed that the mean IOPs after 15 and 30 min were significantly greater than the baseline IOP (P < 0.001 and P = 0.002, respectively); however, the difference in mean IOPs after 45 and 60 min were not statistically significant from the baseline IOP. The averages of IOP peak and IOP fluctuation after the WDT were 20.0 ± 3.5 and 4.2 ± 2.9 mmHg, respectively. IOP fluctuation in those who underwent trabeculotomy alone was twice that of those with GDDs, but the difference was not statistically significant (5.0 vs 2.5 mmHg; P = 0.08). CONCLUSION: In patients with PCG, WDT induced significant IOP elevation 15 and 30 min after the test, which returned to pre-test values after 45 min.

Evaluation of Intraocular Pressure After Water Drinking Test in Patients with Unilateral Hemifacial Spasm.

PURPOSE: The aim of the study is to examine the baseline intraocular pressure (IOP) and its changes after performing a water drinking test (WDT) in patients with unilateral hemifacial spasm (HFS). PATIENTS AND METHODS: In this prospective observational study, patients aged 21 years and above diagnosed with unilateral HFS were recruited from the Singapore National Eye Centre between January 2015 and August 2016. The unaffected eye of each patient served as a matched control. An interviewer-administered standardized questionnaire on HFS symptoms and ophthalmic examination was performed. Automated perimetry, optical coherence tomography (OCT) of the optic nerve head, color disc stereophotography and water drinking test (WDT) were done. The primary outcome measure was the difference in IOP between eyes affected by HFS and fellow eyes at baseline and at 15, 30 and 45 minutes of the WDT. RESULTS: Fifty-four patients with unilateral HFS were included. Mean age was 59.8±9.9 years (range, 37.0-84.0). Of these, 54% were female and 94% were Chinese. Mean baseline IOP was significantly higher in eyes with HFS (13.9±3.1mmHg) compared to fellow eyes (13.3±2.8mmHg) (p=0.008). There was no significant difference in absolute or percentage change in IOP from baseline between the 2 groups at 15, 30 and 45 minutes of the WDT. Mean vertical cup-disc ratio (VCDR) on clinical examination was significantly higher in eyes with HFS (0.5±0.2) compared to fellow eyes (0.4±0.2) (p=0.02). There was no significant difference between the groups for visual field parameters and mean retinal nerve fiber layer thickness on OCT. CONCLUSION: Hemifacial spasm is associated with a small but significant difference in mean baseline IOP and VCDR between affected and fellow eyes. However, when eyes affected by HFS and fellow eyes were challenged with the WDT, both responded in similar ways.

Water-drinking Test and Pharmacologic Mydriasis as Provocative Tests in Primary Angle Closure Suspects.

PURPOSE: To compare the water-drinking test (WDT) and pharmacologic mydriasis as provocative tests in patients with primary angle closure suspect (PACS). METHODS: This observational non-randomized comparative study evaluated changes in intraocular pressure (IOP) in 21 patients with PACS who underwent pharmacologic mydriasis and compared it with IOP changes in 26 patients given the WDT. Ocular biometric and anterior chamber parameters were also assessed. Tests were repeated on the same patient two weeks after performing laser peripheral iridotomy (LPI). RESULTS: The mean age ± standard deviation was 60 ± 7 and 57 ± 9 years in the mydriasis and WDT groups, respectively (P = 0.201). Before LPI, both provocative tests were associated with a significant increase in IOP (mydriasis: 15.1 ± 3.1 to 16.6 ± 3.5 mmHg, P = 0.025; WDT: 16.2 ± 2.8 to 18.5 ± 3.3 mmHg, P < 0.001). However, the IOP changes were not statistically different between groups (P = 0.102). After LPI, only the WDT group showed a continued significant IOP elevation after the test (mydriasis: 16.4 ± 3.3 to 16.7 ± 3.5 mmHg, P = 0.569; WDT: 14.9 ± 3.0 to 17.8 ± 4.1 mmHg, P < 0.001). The post-test IOP change was significantly greater in the WDT than in the mydriasis group (3.0 versus 0.3 mmHg, respectively; P = 0.002). Step-wise multiple regression analysis verified the type of provocative test as the only independent factor affecting the post-test IOP change after LPI (regression coefficient: 2.664; P = 0.002). CONCLUSION: Pharmacologic mydriasis and the WDT had similar IOP elevation before LPI, but after LPI, IOP elevation was much greater in the WDT group.

Changes of choroidal structure and circulation after water drinking test in normal eyes.

PURPOSE: To determine whether water drinking test (WDT) alters choroidal structure using binarization of enhanced depth imaging optical coherence tomographic (EDI-OCT) images. METHODS: We performed a prospective study of 57 eyes of 57 normal subjects. The intraocular pressure (IOP), EDI-OCT images, and laser speckle flowgraphic images were recorded at baseline, and at 15, 30, 45, and 120 min after the WDT. The EDI-OCT images were converted to binary images using ImageJ software, and we examined luminal area, interstitial area, whole choroidal area, the ratio of luminal area to whole choroidal area (L/W ratio), subfoveal choroidal thickness (SCT), and central retinal thickness (CRT). RESULTS: The luminal area, L/W ratio, whole choroidal area, and IOP were significantly increased 30 min after water drinking; levels returned to the baseline at 120 min. No significant changes were found in the CRT and interstitial area. The fluctuations in the SCT after water intake were significantly correlated with those in the L/W ratio and luminal area but not with those of the interstitial area. The choroidal blood flow velocity was significantly decreased at 30 min. Fluctuations in the luminal area, L/W ratio, and whole choroidal area were significantly correlated with IOP fluctuations. CONCLUSIONS: The changes in the SCT after water drinking were mainly due to the changes in the choroidal vascular space. Dilatations of the choroidal vessels after water drinking may lead to choroidal thickening and subsequent IOP elevation. These findings should be considered in the evaluation of choroidal structure in patients with retinal disease.

Role of the water-drinking test in medically treated primary open angle glaucoma patients.

PURPOSE: The water-drinking test (WDT) has recently re-emerged as a possible way to determine the competency of the trabecular meshwork. We performed a prospective interventional study to test the hypothesis that the WDT could be useful in assessing fluctuations in patients undergoing treatment for primary open angle glaucoma (POAG). METHODS: We included 122 patients; 62 on medical treatment for POAG (n=123 eyes) and 60 controls (n=120 eyes). The study group had been on intraocular pressures (IOP) lowering treatment continuously for at least 3months with stable IOP. The WDT was performed during fasting and was considered positive if it fluctuated ≥6mmHg. RESULTS: The patients on medical treatment had a mean age of 50.56±18.45 years vs. 51.35±11.22 for the controls (P=0.34); with 71% being female in the study group and 77% in the control group. In the study group; 52% were on beta blockers (n=64), 27% combination of two or more medications (n=33), 19% prostaglandin analogues (n=24) and 2% alpha agonists (n=2). The WDT was positive in 17.07% (n=21) in the study group and 2.5% (n=3) in the control group (P=0.0001). The mean fluctuation was 7.14±2.15mmHg in the study group and 6.00±0mmHg in the controls (P=0.33). A positive WDT was found in 33.33% (n=11) of those on combination therapy; 12.5% (n=3) prostaglandin analogues and 10.94% (n=7) beta blockers (P=0.03). Combination therapy had the highest positive WDT fluctuation (7.54±2.87) followed by prostaglandin analogues (7.00±1.00) and beta blockers (6.57±0.78) with a P value of 0.44. CONCLUSIONS: The WDT can identify significant fluctuations in eyes with POAG that are medically treated.

The Water-Drinking Test Revisited: An Analysis of Test Results in Subjects with Glaucoma.

PURPOSE: The Water-Drinking Test (WDT) has been shown to predict the diurnal IOP change. This study evaluates the factors that may affect the WDT results. METHODS: This study was conducted on 203 glaucoma patients who had undergone trabeculectomy (53) or tube surgery (31), or had a medically controlled open-angle (82) or closed-angle (37) glaucoma. IOP was measured at baseline and then every 15 minutes over a one-hour period after drinking water. The main outcome measures were IOP change (increase in IOP from baseline) at all measurement time points, IOP peak (highest IOP after drinking water), IOP fluctuation (difference between IOP peak and baseline), and assessing the association of these IOPs with a patient's demographic and management modalities. RESULTS: The mean age of the participants was 54±18 years, and 113 (56%) were male. Female patients showed greater IOP fluctuation than males (7.28 vs. 5.92 mm Hg; P=0.016), and a greater IOP peak (22.7 vs. 20.1 mm Hg; P=0.001). The observed associations between gender and IOP changes were only significant in <50 years. IOP at 60 minutes was greater in tube than trabeculectomy (5.6 vs. 3.1 mm Hg; P=0.007). The number of topical medications showed a direct independent association with IOP changes (P<0.001). Compared to other classes of topical medications, latanoprost showed lower WDT-IOP profile (P=0.0003). CONCLUSIONS: WDT-IOP change was diminished in subjects on latanoprost, and was greater in females <50 years, and those on greater number of medications.

Water Drinking Test: Intraocular Pressure Changes after Tube Surgery and Trabeculectomy.

PURPOSE: To study the effects of filtration surgeries (tube and trabeculectomy) on changes in intraocular pressure after a water-drinking test. METHODS: In this prospective, non-randomized, comparative clinical study, 30 patients who had tube surgery and 30 age- and sex-matched trabeculectomy patients underwent a water-drinking test. Only one eye of each patient was included. The baseline intraocular pressure was ≤21 mmHg in all enrolled eyes with or without adjunctive topical medications. After the water-drinking test, the intraocular pressure was measured and recorded at 15, 30, 45, and 60 minutes and the results were compared between the two groups. RESULTS: In both groups, intraocular pressure significantly increased from baseline at all measured time-points (P < 0.001). In the trabeculectomy group, the average intraocular pressure increased from 14.8 ± 2.9 to 18.8 ± 4.7 mmHg at 30 minutes, but decreased at 60 min (18.0 ± 5.2 mmHg). In the Tube group, intraocular pressure increased incrementally until the last measurement (14.2 ± 3.9, 18.8 ± 5.6, and 19.7 ± 6.0 mmHg at baseline, 30, and 60 minutes, respectively). The end-pressure difference (intraocular pressure at 60 minutes vs. baseline) was significantly greater in the tube group (5.6 ± 3.6 mmHg; 41% change) than in the trabeculectomy group (3.2 ± 4.7; 23% change; P = 0.03). CONCLUSION: Intraocular pressure significantly increased after the water-drinking test in both the groups. Intraocular pressure started to decline 30 minutes after the water-drinking test in the trabeculectomy group, while it continued to increase up to 60 minutes in the Tube group. This finding may have implications regarding the efficacy or safety of the procedures in advanced glaucoma patients.

Clinical Observation of Acupuncture-activating Method for Deglutition Disorder Due to Pseudobulbar Palsy After Cerebral Stroke / 上海针灸杂志

Objective To observe the clinical efficacy of ZHU Lian's acupuncture-activatingmethod in treating deglutition disorder due to pseudobulbar palsy after cerebral stroke.Method Sixty patients with deglutition disorder due to pseudobulbar palsy after cerebral stroke in acute stage were randomized into an observation group and a control group, 30 cases in each group. The two groups both received symptomatic neurological treatment. In the two groups, acupoints including Lianquan (CV23), Huiyan (Extra), Baihui (GV20), and bilateral Shuaigu (GB8), Wangu (GB12), Zhaohai (KI6), Lieque (LU7),and Yinlingquan (SP9) were selected. The observation group was intervened by ZHU Lian's acupuncture-activating method; the control group was intervened by ordinary needling method plus G6805 therapeutic appliance with sparse-dense wave for 20 min. Prior tothe treatment and after 10 treatment courses, the two groups were evaluated by using Videofluoroscopic Swallowing Study (VFSS) and Kubota's water drinking test for swallowing function.Result After 10 treatment courses, the total effective rate was 96.7%in the observation group versus 83.3% in the control group, and the between-group difference was statistically significant (P<0.05); the VFSS score in the observation group was significantly different from that in the control group (P<0.01); the water drinking test score in the observation group was significantly different from that in the control group (P<0.01). The results indicated that the therapeutic efficacy was more significant in the observation group compared to that in the control group.Conclusion ZHU Lian's acupuncture-activating method can produce a more significant efficacy in treating deglutition disorder due to pseudobulbar palsy after cerebral stroke in acute stage compared with sparse-dense-wave electroacupuncture.