Clinical Profile and Intraocular Pressure Control of Medically Treated Glaucoma Patients Seen in a Tertiary Hospital in Enugu, Nigeria

Abstract

Background: Glaucoma is the second most common cause of blindness and the leading cause of irreversible blindness worldwide. It is a chronic optic neuropathy with characteristic optic disc changes and corresponding visual field defect. Aim: The aim of this study was to determine the clinical profile and intraocular pressure control of Primary Open Angle Glaucoma (POAG) patients on medical treatment at the glaucoma clinic of Enugu State University of Science and Technology Teaching Hospital Parklane (ESUTTHP), Enugu with a view for better patient management. Methods: The study was a hospital based cross sectional study on POAG patients on medical treatment attending the eye clinic of ESUTTHP, Enugu. Patients were selected by simple random sampling. Their eyes were examined which included visual acuity assessment, follow-up clinic intraocular pressure measurement, gonioscopy, anterior and posterior segments examination. Water Drinking Test (WDT) and modified phasing were carried out on them. WDT was done over 2 hours after intake of 1 liter of water with intraocular pressure measured every 15 minutes. Modified phasing was done over 8 hours with intraocular pressure measured at 2 hourly intervals. Data analysis was done using SPSS version 20 (U.S.A). The mean follow-up clinic intraocular pressure (IOP), IOP peak and fluctuation during WDT and phasing were determined and compared using T-test. Results: A total of 130 primary angle glaucoma patients on medical treatment were examined comprising of 43.1% males and 56.9% females with mean age of 62.25±9.002. Few of the patients were blind (3.8%) while 66.2% had normal vision. Their mean vertical cup disc ratio was 0.78±0.13. Majority of the patients had thin central cornea and uncontrolled intraocular pressure. The mean follow-up clinic IOP, mean IOP peaks during WDT and phasing were 16.2±4.3, 22.9±5.7, 18.0±4.4mmHg, respectively. There was a significant correlation between central corneal thickness and IOP peaks in WDT and modified phasing as well as follow-up clinic IOP but there was no significant correlation between central corneal thickness and IOP fluctuations in WDT and modified phasing. There was a significant correlation between vertical cup disc ratio and IOP peaks in WDT as well as vertical cup disc ratio and follow-up clinic IOP (p< 0.01). Conclusion: Few patients are blind from glaucoma but greater percentage still have uncontrolled IOP despite being on medical treatment. Therefore, other treatment options should be explored to bring their IOP under control to avoid further glaucomatous progression and consequent blindness.