Abstract
Aim This study assessed the 24 h circadian rhythm of intraocular pressure (IOP) using a contact lens sensor in three groups of patients with open-angle glaucoma. Methods This study was a monocentric, cross-sectional, nonrandomized, prospective, pilot study. Eighty-nine patients were enrolled: 29 patients previously underwent an Ex-PRESS mini glaucoma device procedure (Group 1), 28 patients previously underwent Hydrus microstent implantation (Group 2), and 32 patients were currently being treated medically for primary open-angle glaucoma (Group 3). Circadian rhythm patterns were considered with five circadian indicators: fluctuation ranges, maximum, minimum, acrophase (time of peak value), and bathyphase (time of trough value). A two-tailed Mann–Whitney U-test was used to evaluate differences between groups. Results All subjects exhibited a circadian rhythm and a nocturnal pattern. The signal fluctuation range was significantly smaller in the surgical groups than in the medically treated group (Group 1 vs. Group 3, p=0.003; Group 2 vs. Group 3, p=0.010). Subjects who underwent the Ex-PRESS procedure (Group 1) exhibited significant differences compared with the drug therapy group (Group 3) with regard to the minimum value (p=0.015), acrophase (p=0.009), and bathyphase (p=0.002). The other circadian indicators were not significantly different among groups. Conclusions Patients who underwent IOP-lowering surgery had an intrinsic nyctohemeral rhythm. Both surgical procedures, Ex-PRESS and Hydrus, were associated with smaller signal fluctuations compared with medical treatment.
Highlights
Glaucoma is the principal cause of irreversible vision loss and the second leading cause of blindness worldwide. e number of people aged 40–80 years with glaucoma was estimated to be 64.3 million in 2013, and this number is expected to increase to 76.0 million by 2020 and 111.8 million by 2040 [1]. e management of glaucoma focuses on lowering intraocular pressure (IOP), which still remains the rational proven treatment method [2]
Eighty-nine patients were enrolled and divided into three groups based on their treatment history: Group 1 previously underwent Ex-PRESS mini glaucoma device implantation (29 patients, Contact lens sensors (CLSs) applied on the operated eye), Group 2 previously underwent Hydrus implantation (28 patients, CLS applied on the operated eye), and Group 3 was currently undergoing medical treatment with two drugs
Ophthalmic Data. e demographics and clinical data of the three groups are shown in Table 1. e mean age of our population was 73.96 years, with no difference between groups. e patients comprised 38 men and 51 women
Summary
Glaucoma is the principal cause of irreversible vision loss and the second leading cause of blindness worldwide. e number of people aged 40–80 years with glaucoma was estimated to be 64.3 million in 2013, and this number is expected to increase to 76.0 million by 2020 and 111.8 million by 2040 [1]. e management of glaucoma focuses on lowering intraocular pressure (IOP), which still remains the rational proven treatment method [2]. Current management of glaucoma includes medical, laser, or surgical reduction of IOP to a predetermined target. Is device can record signal fluctuations in an outpatient setting for up to 24 h, including during undisturbed sleep. It provides a paradigmatic change in IOP evaluation, both clinically and experimentally. It is generally established that surgery offers better IOP control than medical therapy, but surgery may be associated with complications and failures. For this reason, surgery is usually reserved for advanced or clearly progressive glaucoma. We evaluated the patterns of circadian signal fluctuation curves and five circadian indicators: fluctuation range, maximum, minimum, acrophase (time of peak value), and bathyphase (time of trough value)
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