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. 2017 Oct 4;12(10):e0185246.
doi: 10.1371/journal.pone.0185246. eCollection 2017.

Fluctuation of intraocular pressure in glaucoma patients before and after trabeculectomy with mitomycin C

Joanna Wasielica-Poslednik  1 , Julian Schmeisser  1 , Esther M Hoffmann  1 , Veronika Weyer-Elberich  2 , Katharina Bell  1 , Katrin Lorenz  1 , Norbert Pfeiffer  1
Affiliations

Fluctuation of intraocular pressure in glaucoma patients before and after trabeculectomy with mitomycin C

Joanna Wasielica-Poslednik et al. PLoS One. .

Abstract

Purpose: Intraocular pressure (IOP) fluctuation is considered as a risk factor for glaucoma progression. We investigated IOP values and IOP fluctuation before and after trabeculectomy (TE) with mitomycin C (MMC) measured by 48-hour diurnal-nocturnal-IOP-profiles (DNP).

Methods: Pre- and postoperative DNPs of 92 eyes undergoing primary TE with MMC were analysed. Each 48-hour IOP-profile involved 10 IOP measurements (8:00 a.m., 2:00 p.m., 6:00 p.m., and 9:00 p.m. in sitting and at 00:00 in supine position). The "preoperative DNP" was performed a few weeks before TE. The "postoperative DNP" was performed at least six months (range: 6 months-2 years) after TE. Mean IOP values and IOP fluctuations were calculated.

Results: After TE with MMC mean IOP was reduced from 16.94±3.83 to 11.26±3.77 mmHg at daytime and from 18.17±4.26 to 11.76±3.90 mmHg at night. At daytime mean IOP-fluctuation decreased from 8.61±4.19 to 4.92±2.52 mmHg, at night from 3.15±2.95 to 1.99±1.82 mmHg. Mean IOP was lower on the second day of the preoperative DNP. This effect was not present in the postoperative DNP. Preoperatively, IOP was controlled in all eyes with a mean of 3.22±0.94 antiglaucomatous agents. Postoperatively, IOP≤15 mmHg was achieved in 71.7%, IOP≤18 mmHg in 77.1% and a decrease in IOP of >30% in 47.8% without antiglaucomatous therapy. Postoperatively, pseudophakia was associated by a higher mean IOP-fluctuation compared to the phakic eyes.

Conclusions: TE with MMC significantly reduces both mean IOP-values and IOP- fluctuations at day and night at least 6 months postoperatively. The effect of TE on the IOP fluctuation was less pronounced in pseudophakic eyes.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Mean intraocular pressure (IOP) measured during daytime, at night and during the whole first (“pre-op”) and second diurnal-nocturnal IOP (“post-op”) profile [mmHg].
Outliers—values beyond 1.5 x interquartile range—are marked as circles (“out” values) and stars (“far out” values).
Fig 2
Fig 2. Course of the intraocular pressure values (IOP) at all timepoints in the first (”pre-op”) and second diurnal-nocturnal IOP profile (”post-op”).
Fig 3
Fig 3. Number of patients who achieved mean IOPtotal ≤ 15 mmHg and ≤ 18 mmHg with or without antiglaucomatous therapy during the first (“pre-op”) and second diurnal-nocturnal IOP profiles (“post-op”).
Fig 4
Fig 4. Number of eyes which achieved an IOP-decrease > 30% with or without antiglaucomatous therapy in the second diurnal-nocturnal IOP profile.
Fig 5
Fig 5. Mean intraocular pressure values (IOP) on the first and second day of the first diurnal-nocturnal IOP profile.
Outliers—values beyond 1.5 x interquartile range—are marked as circles (“out” values) and stars (“far out” values).
Fig 6
Fig 6. Mean intraocular pressure (IOP) fluctuations measured at daytime, at night and during the whole first (“pre-op”) and second diurnal-nocturnal IOP (“post-op”) profile [mmHg].
Outliers—values beyond 1.5 x interquartile range—are marked as circles (“out” values) and stars (“far out” values).
Fig 7
Fig 7. Course of the intraocular pressure (IOP) fluctuations at all timepoints during the first (”pre-op”, blue line) and second diurnal-nocturnal IOP profile (”post-op”, green line) [mmHg].
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