Clininal Study Of Water Drinking Test And Twenty-four-hour Monitoring Of IOP In Patient With Primary Open-angle Glaucoma

Background and PurposePrimary open angle glaucoma(POAG) is a type of glaucoma, when the intraocular pressure is raise, the angle is open. Main pathological manifestation of POAG is the trabecular meshwork and Schlemm tube subendothelial extracellular deposition of material.The level of intraocular pressure (IOP) is one of the most determined factor for POAG, But some patients whose IOP is controled to satisfied level still have visual field loss. This is because the time of outpatient can not obtaine diurnal IOP fluctuation, The 24 hours monitorin can observe IOP spikes and fluctuation.But this method required hospitalization and cooperation of patients for measurement. Water drinking tests (WDT) is easily operat and accepted by the patients. The purpose of this study is to observe the relevance of 24 hours monitoring and water drinking test and find a simple and effective method to assess IOP fluctuation.The IOP fluctuation of surgery and drug treatment of POAG were compared, and to evaluate the effect of two treatments. MethodsA prospective study.55 (90 eyes) patients with POAG was selected in the study. 30 cases (48 eyes) were randomly divided into the group which were treat by trabeculectomy, the other 25cases (42 eyes) were treat by antiglaucoma medication. All of the eyes were measured 24 hours IOP monitorin and WDT before and 6 months after treatment,24 hours IOP monitorin every 3 hours in each eye from the early morning 7:00 to the next day 4:00. Do correlation analysis of IOP spikes and IOP fluctuation range from the results of 24 hours IOP monitorin and WDT. Compare IOP spikes and IOP fluctuation range from the results of 24 hours IOP monitorin of surgery and drug treatment.All results are expressed as the Mean±SD. Statistical analyses were performed with SPSS 17.0 software. It was considered significant if P value was<0.05 between groups.Results1. The POAG before treatment, the IOP peak value occurres in the daytime in 43 eyes (47.8%), and 47 eyes (52.2%) in night;2. The POAG before treatment, The average amplitude of 24-hour IOP is 8.18±2.26mmHg; The total of IOP fluctuation less than 6 mmHg are 23 eyes (25.6 %),between 6 mmHg and 8mmHg are 29 eyes (32.2%),more than 8mmHg are 41 eyes (45.6%);3. The POAG before treatment, The product-moment correlation coefficient of IOP spike from the results of 24 hours IOP monitorin and WDT is 0.758, the IOP spike of two methods have high correction; 6 months after treatment, The product-moment correlation coefficient of IOP spike from the results of 24 hours IOP monitorin and WDT is 0.780, the average IOP spike of two methods have high correction;4. The average 24-hour IOP of surgery group and drug treatment group is 15.06±2.54mmHg and 13.84±2.76mmHg, The 24-hour IOP spike of surgery group and drug treatment group is 17.53±2.80mmHg and 16.04±3.10mmHg, The average 24-hour IOP amplitude of surgery group and drug treatment group is 5.07±1.40mmHg and 4.33±1.48mmHg, The average IOP、average IOP spike and average IOP amplitude of surgery group and drug treatment group all have statistically significant difference(P<0.05).Conclusions1. The POAG before treatment, the IOP peak value occurres in the exception of the time of outpatient 47 eyes (52.2%), the time of outpatient can not obtaine diurnal IOP fluctuation;2. The POAG before treatment, The average amplitude of 24-hour IOP is 8.18±2.26mmHg; The total of IOP fluctuation less than 6 mmHg are 23 eyes (25.6 %),between 6 mmHg and 8mmHg are 29 eyes(32.2%),more than 8mmHg are 41 eyes (45.6%).Pay attention to control amplitude of IOP is necessary;3. The POAG before and after treatment, The IOP spike from the results of 24 hours IOP monitorin and WDT have high correlation, WDT IOP spikes can reflect the spike of 24 hours IOP monitorin, can be used to assess the current treatment situation;4. The average IOP spike and average IOP amplitude of surgery group and drug treatment group all have statistically significant difference, surgery group can get alower average IOP spike and average IOP amplitude.