Clinical Ophthalmology (May 2020)
Individualized Significance of 24-Hour Intraocular Pressure Curves for Therapeutic Decisions in Primary Chronic Open-Angle Glaucoma Patients
Abstract
Mael Lever,1 Jan Darius Unterlauft,2 Christian Halfwassen,1 Nikolaos E Bechrakis,1 Anke Manthey,1 Michael RR Böhm1 1Department of Ophthalmology, University Hospital Essen, Essen, Germany; 2Department of Ophthalmology, University Hospital Leipzig, Leipzig, GermanyCorrespondence: Mael LeverDepartment of Ophthalmology, University Hospital Essen, Hufelandstr. 55, Essen 45147, GermanyTel +49 201 723 2900Fax +49 201 723 5917Email [email protected]: Diagnostic 24-hour intraocular pressure curves (IPC) are well established in the management of glaucoma. However, objective criteria for the IPC indication are lacking. The aim of this study was to evaluate the impact of individual patient characteristics and glaucoma-related parameters on therapy decisions after IPC and thus examine their relevance for glaucoma management.Patients and Methods: Retrospective analysis of adult primary open-angle glaucoma (POAG) patients who underwent an IPC (≥ 6 IOP measurements in 24 hours). The main exclusion criterion was previous IOP-lowering surgery. IPC-dependent (eg, mean and peak IOP) and IPC-independent parameters (eg, perimetry, RNFL thickness) were analyzed in relation to the therapeutic decision after IPC. Further, these parameters were compared in patient subgroups based on age, glaucoma stage, or therapy intensity.Results: A total of 101 eyes of 101 patients were included. In general, mean and peak IOP were elevated in patients with a therapeutic change after IPC. These subjects presented differences of IPC-independent parameters (eg, IOP at admission, RNFL thickness, glaucoma stage). Regression analysis results suggested a predictive role of IPC-independent parameters for IPC therapeutic decisions. In subgroups of patients of older age or advanced glaucoma, IPC-independent parameters did not correlate with therapeutic decisions after IPC.Conclusion: These results support the relevance of IPC in the therapeutic management of POAG. Moreover, the study promotes a personalized classification of patients using selected glaucoma characteristics to objectivize their individual benefit from IPC. Further prospective studies are needed to verify the utility of these parameters and IPC in the management of glaucoma.Keywords: glaucoma management, IOP phasing, diagnostic, antiglaucomatous therapy
