[Diurnal Fluctuations of Intraocular Pressure, Blood Pressure, and Ocular Perfusion Pressure in Glaucoma Patients].

BACKGROUND: An elevated intraocular pressure remains the main risk factor for the development and progression of glaucoma but other factors such as fluctuations of the intraocular pressure, the blood pressure, and the ocular perfusion pressure are gaining in importance. The influence of the anti-glaucomatous therapies on these parameters is barely investigated. This study investigates 1) a correlation between the fluctuations of the intraocular pressure, the blood pressure and the ocular perfusion pressure with the severity of the glaucoma damage and 2) if these parameters can be influenced by different anti-glaucomatous therapies.
MATERIAL AND METHODS: Data from 121 glaucoma patients who had been hospitalised for 24-hour measurements of the intraocular pressure and blood pressure between 2003 and 2012 were analysed retrospectively. The patients were divided into groups by the severity of the glaucoma damage and by their anti-glaucomatous therapy. Mean values for the intraocular pressure, the blood pressure and the ocular perfusion pressure were calculated and correlated with the individual groups. The statistical analysis was performed with SPSS21.0 using Kruskal-Wallis and Mann-Whitney U tests for the comparison of the groups. RESULTS with p < 0.05 were considered statistically significant.
RESULTS: The severity of the glaucoma damage correlated significantly with higher mean values of the intraocular pressure and its fluctuations, as well as with a nocturnal decrease of the blood pressure and low mean values of the ocular perfusion pressure (p < 0.0001). The anti-glaucomatous therapy decreased the intraocular pressure to normal values. A monotherapy with carboanhydrase inhibitors correlated with the lowest fluctuations of the ocular perfusion pressure while a quadri-therapy was associated with higher values of the intraocular pressure and its fluctuations. The anti-glaucomatous therapy did not show an association with the blood pressure or the ocular perfusion pressure.
CONCLUSION: Glaucoma is negatively influenced by high intraocular pressure, nocturnal blood pressure decreases and ocular perfusion pressure fluctuations. A monotherapy with carboanhydrase inhibitors seems to be sufficient to decrease fluctuations of the intraocular pressure. Patients with a quadri-therapy should be monitored regularly as they present high values of intraocular pressure and its fluctuations. A hospitalisation of the patients with 24-hour measurements of the intraocular pressure and blood pressure provides information needed to improve the therapy or decide about surgical interventions. Georg Thieme Verlag KG Stuttgart · New York.