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Editors Selection IGR 13-4

Intraocular Pressure: Effect of trabeculectomy on IOP variability

Comment by Tony Realini on:

47597 Diurnal and Nocturnal Intraocular Pressure Fluctuations after Trabeculectomy, Klink T; Praetorius S; Leippi S et al., Ophthalmologica, 2011;

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Klink et al. (1820) have conducted a retrospective analysis of 35 eyes of 35 patients who submitted to 24-hour intraocular pressure (IOP) curves before and after trabeculectomy to characterize the effects of surgery on IOP variability. Postoperative IOP curves were obtained at least 300 days after surgery. Analysis consisted of evaluating changes in peak and range of IOP separately for the diurnal and nocturnal periods. They found that peak preoperative IOP was 26.5 ± 5.9 mmHg and 23.4 ± 5.2 mmHg in the diurnal and nocturnal periods, respectively, while postoperative values were 16 ± 4.4 mmHg and 16 ± 5.4 mmHg, respectively. Likewise, diurnal fluctuation was reduced from 12.1 ± 4.2 mmHg preoperatively to 5.6 ± 2.2 mm Hg postoperatively, and nocturnal fluctuation from 7.1 ± 4.5 to 3.9 ± 4.1 mmHg. In context, this study confirms what is known about trabeculectomy's IOP lowering profile: it lowers both peak and range of IOP. What makes this study interesting is the nocturnal data, as there is relatively little available information on the effect of trabeculectomy on nighttime IOP. Their data supports that trabeculectomy lowers both peak and range of IOP at night as well as during the day. A weakness of the study is that nocturnal data was collected in the seated position, which poorly relects true IOP in the supine position. Recent studies from the lab of Liu and Weinreb have shown convincingly that IOP in the habitual position (seated during the day and supine at night) is higher at night than during the day. It would have been interesting to know what effect trabeculectomy had on IOP variability at night in the supine position, but in this retrospective study, such data was not collected and was not available for analysis.

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