To describe and compare the diurnal intraocular pressure (IOP) variation in patients with pseudoexfoliation syndrome (PXS) and normal subjects.
Methods
The authors prospectively investigated 19 PXS patients (10 bilateral and 9 unilateral) and 25 age- and sex-matched normal subjects. One eye of each control subject and bilateral PXS patient was selected randomly, and pseudoexfoliative eyes of unilateral cases were enrolled in this study. All patients were admitted to the authors' ophthalmology department and underwent diurnal IOP testing (six measurements over 24 hours).
Results
The mean IOP of PXS patients at all time intervals was significantly higher than the control group (p<0.05). Likewise, a significant difference in the maximum IOP, range of IOP, and minimum IOP, as well as the standard deviation of the pressure at each time point, existed between groups (p<0.05). Normal individuals did not show diurnal variation greater than 5 mmHg. Of patients with PXS, 55.6% showed diurnal variation greater than 5 mm Hg. In addition, in 10% of patients with PXS, the diurnal variations were equal to or higher than 10 mmHg.
Conclusions
Variations in IOP during the daily 24-hour cycle in patients with PXS were higher than control groups. Significant fluctuations in the diurnal curve of IOP in PXS may be an important factor in predicting eyes that may develop pseudoexfoliative glaucoma. IOP fluctuation could influence the diagnostic and prognostic evaluation of PXS.
ArmalyM.F.On the distribution of applanation pressure. I. Statistical features and the effect of age, sex, and family history of glaucoma. Arch Ophthalmol1965; 73: 11–8.
2.
BengtssonB.Some factors affecting the distribution of intraocular pressures in a population. Acta Ophthalmol1972; 50: 33–46.
3.
ZeimerR.C.Circadian variations in intraocular pressure. In: RitchR., ShieldsM.B., KrupinT., eds. The Glaucomas, 2nd ed.St. Louis, MO: Mosby; 1996: 429–45.
4.
Sidler-HugueninA.Die Spaterfolge der glaukombehandlung bei 76 Privatpatienten von Prof Haab, Zurich. Beitr Z Augenheilkd1898; 32: 1.
5.
WaxM.B., CamrasC.B., FiscellaR.G., GirkinC., SinghK., WeinrebR.N.Emerging perspectives in glaucoma: optimizing 24-hour control of intraocular pressure. Am J Ophthalmol2002; 133: S2–S10.
6.
WorthenD.M.Intraocular pressure and its diurnal variation. In: HeilmannK., RichardsonK.T., eds. Glaucoma: Conceptions of a Disease.Philadelphia: Saunders; 1978: 54–66.
7.
WilenskyJ.T.Diurnal variations in intraocular pressure. Trans Am Ophthalmol Soc1991; 89: 757–90.
8.
DavidR., ZangwillL., BriscoeD., DaganM., YagevR., YassurY.Diurnal intraocular pressure variations: an analysis of 690 diurnal curves. Br J Ophthalmol1992; 76: 280–3.
9.
SaccaS.C., RolandoM., MarlettaA., MacriA., CerquetiP., CiurloG.Fluctuations of intraocular pressure during the day in open-angle glaucoma, normal-tension glaucoma and normal subjects. Ophthalmologica1998; 212: 115–9.
SampaolesiR., CalixtoN., De CarvalhoC.A., RecaR.Diurnal variation of intraocular pressure in healthy, suspected and glaucomatous eyes. Bibl Ophthalmol1968; 74: 1–23.
12.
DavangerM.Diurnal variations of ocular pressure in normal and in glaucomatous eyes. Acta Ophthalmol1964; 42: 764–72.
13.
AsraniS., ZeimerR., WilenskyJ., GieserD., VitaleS., LindenmuthK.Large diurnal fluctuations in intraocular pressure are an independent risk factor in patients with glaucoma. J Glaucoma2000; 9: 134–42.
14.
LiuJ.H.K.Diurnal measurement of intraocular pressure. J Glaucoma2001; 10: 39–41.
15.
RitchR.Exfoliation syndrome: the most common identifiable cause of open-angle glaucoma. J Glaucoma1994; 3: 176–8.
16.
HansenE., SellovoldO.J.Exfoliation of lens capsulature. III. Ocular tension in eyes with exfoliation. Acta Ophthalmol1970; 48: 446–54.
17.
HillerR., SperdutoR.D., KruegerD.E.Exfoliation, intraocular pressure, and senile lens changes in a population based survey. Arch Ophthalmol1982; 100: 1080–2.
18.
KlemettiA.Intraocular pressure in exfoliation syndrome. Acta Ophthalmol1988; 66(Suppl): S54–8.
19.
TomitaG., PuskaP., RaittaS.Interocular differences in optic disc configuration in the unilateral exfoliation syndrome. Acta Ophthalmol1994; 72: 162–7.
20.
HirveläH., TuulonenA., LaatikainenL.Intraocular pressure and prevalence of glaucoma in elderly people in Finland: a population-based study. Int Ophthalmol1995; 18: 299–307.
21.
RingvoldA., BlikaS., ElsasT.The Middle-Norway eye-screening study. II. Prevalence of simple and capsular glaucoma. Acta Ophthalmol1991; 69: 273–80.
22.
KonstasA.G.P., StewartW.C., StromanG.A., StromanG.A., SineC.S.Clinical presentation and initial treatment patterns in patients with exfoliation versus primary open-angle glaucoma. Ophthalmic Surg Lasers1997; 28: 111–7.
23.
KonstasA.G.P., MantzirisD.A., StewartW.C.Diurnal intraocular pressure in untreated exfoliation and primary open-angle glaucoma. Arch Ophthalmol1997; 115: 182–5.
24.
KatavistoM.The diurnal variation of ocular tension in glaucoma. Acta Ophthalmol1964; 78: 1–131.
25.
RadnotM., FollmannP.Diagnosis of primary open-angle glaucoma. In: BellowsJ.G., ed. Glaucoma: Contemporary International Concepts.New York: Masson; 1979: 213–38.
26.
ZeimerR.C., WilenskyJ.T., GieserD.K., VianaM.A.G.Association between intraocular pressure peaks and progression of visual field loss. Ophthalmology1991; 98: 64–9.
27.
KitazawaY., HorieT.Diurnal variation of intraocular pressure in primary open-angle glaucoma. Am J Ophthalmol1975; 79: 557–66.
28.
SmithJ.P.Diurnal IOP correlation to automated perimetry. Ophthalmology1985; 92: 955–8.
29.
MaoL.K., StewartW.C., ShieldsM.B.Correlation between intraocular pressure control and progressive glaucomatous damage in primary open-angle glaucoma. Am J Ophthalmol1991; 111: 51–5.
30.
O'BrienC., SchwartzB., WuD.C.Intraocular pressure and rate of visual field loss in chronic open-angle glaucoma. Am J Ophthalmol1991; 111: 491–500.
31.
ShirakashiM., IwantaK., SawaguchiS., AbeH., NanbaK.Intraocular pressure-dependent progression of visual field loss in advanced primary open angle glaucoma: a 15-year follow up. Ophthalmologica1993; 207: 1–5.
32.
StewartW.C., ChorakR.P., HuntH.H., SethuramanG.Factors associated with visual loss in patients with advanced glaucomatous changes in the optic nerve head. Am J Ophthalmol1993; 116: 176–81.
33.
DavangerM., RingvoldA., BlikaS.Pseudoexfoliation, IOP and glaucoma. Acta Ophthalmol1991; 69: 569–73.
34.
HansenE., SellovoldO.J.Pseudoexfoliation of the lens capsule II. Development of the exfoliation syndrome. Acta Ophthalmol1969; 47: 161–73.
35.
HenryJ.C., KrupinT., SchmittM.Long-term follow-up of pseudoexfoliation and the development of elevated intraocular pressure. Ophthalmology1987; 94: 545–52.
36.
PuskaP.M.Unilateral exfoliation syndrome. Conversion to bilateral exfoliation and to glaucoma: a prospective 10-year follow-up study. J Glaucoma2002; 11: 517–24.
37.
MitchellP., WangJ.J., HourihanF.The relationship between glaucoma and pseudoexfoliation. The Blue Mountains Eye Study. Arch Ophthalmol1999; 117: 1319–24.
38.
DranceS.M.The significance of the diurnal tension variations in normal and glaucomatous eyes. Arch Ophthalmol1960; 64: 494–501.
39.
ZeimerR.C., WilenskyJ.T., GieserD.K., VianaM.A.G.Association between intraocular pressure peaks and progression of visual field loss. Ophthalmology1991; 98: 64–9.
40.
AiharaM., YamagamiJ., AraieM., YamamotoS.Relationship of the office intraocular pressure to diurnal fluctuation of intraocular pressure in low-tension glaucoma. A multivariate analysis. Acta Soc Ophthalmol Jpn1992; 96: 1007–13.
41.
ZeimerC.R.Circadian variations in intraocular pressure. In: RitchR., ShieldsB.M., KrupinT.The Glaucomas, vol. 1. St. Louis: Patterson; 1996: 429–45.
42.
LiuJ.H.Circadian rhythm of IOP. J Glaucoma1998; 7: 141–7.
43.
LiuJ.H., KripkeD.F., TwaM.D.Twenty-four-hour pattern of intraocular pressure in the aging population. Invest Ophthalmol Vis Sci1999; 40: 2912–7.
