Abstract
PurposeTo compare the water-drinking test (WDT) and pharmacologic mydriasis as provocative tests in patients with primary angle closure suspect (PACS).MethodsThis observational non-randomized comparative study evaluated changes in intraocular pressure (IOP) in 21 patients with PACS who underwent pharmacologic mydriasis and compared it with IOP changes in 26 patients given the WDT. Ocular biometric and anterior chamber parameters were also assessed. Tests were repeated on the same patient two weeks after performing laser peripheral iridotomy (LPI).ResultsThe mean age standard deviation was 60 7 and 57 9 years in the mydriasis and WDT groups, respectively (P = 0.201). Before LPI, both provocative tests were associated with a significant increase in IOP (mydriasis: 15.1 3.1 to 16.6 3.5 mmHg, P = 0.025; WDT: 16.2 2.8 to 18.5 3.3 mmHg, P < 0.001). However, the IOP changes were not statistically different between groups (P = 0.102). After LPI, only the WDT group showed a continued significant IOP elevation after the test (mydriasis: 16.4 3.3 to 16.7 3.5 mmHg, P = 0.569; WDT: 14.9 3.0 to 17.8 4.1 mmHg, P < 0.001). The post-test IOP change was significantly greater in the WDT than in the mydriasis group (3.0 versus 0.3 mmHg, respectively; P = 0.002). Step-wise multiple regression analysis verified the type of provocative test as the only independent factor affecting the post-test IOP change after LPI (regression coefficient: 2.664; P = 0.002).ConclusionPharmacologic mydriasis and the WDT had similar IOP elevation before LPI, but after LPI, IOP elevation was much greater in the WDT group.
Highlights
The following parameters were collected from the Lenstar biometer: mean keratometry (Km), keratometric astigmatism (Ka), central corneal thickness (CCT), axial length (AL), and lens thickness (LT)
Our results showed that the amount of intraocular pressure (IOP) elevation after pharmacologic mydriasis was less than water-drinking test (WDT)-IOP elevation before and after laser peripheral iridotomy (LPI)
*Factors with P-value less than 0.1 were entered into a multiple stepwise regression model IOP, intraocular pressure; SE, spherical equivalent; WDT, water-drinking test before LPI measurements, while the IOP changes were greater in the WDT group in measurements obtained after LPI than before LPI
Summary
Primary angle closure glaucoma (PACG) is believed to be one of the leading causes of irreversible blindness with approximately 20 million people experiencing PACG worldwide.[1,2,3]. The prone position in the dark room test may induce forward movement of the lens and enhance the effect of the relative pupillary block.[6] this provocative test has a low sensitivity and positive predictive value in detecting eyes susceptible to angle closure glaucoma.[7] we need to identify more appropriate provocative tests to determine PACS patients with the greatest risk of PACG and learn more about the mechanism of angle closure formation
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