Sultan Marla B, Mansberger Steven L, Lee Paul P
New York Eye & Ear Infirmary, New York, New York, USA.
Surv Ophthalmol. 2009 Nov-Dec;54(6):643-62. doi: 10.1016/j.survophthal.2009.05.001. Epub 2009 Aug 8.
Glaucoma is one of the leading causes of visual impairment and blindness. Lowering intraocular pressure (IOP) is the only proven means to slow or halt disease progression among those at higher risk of developing glaucoma and those with early to moderate or more advanced glaucoma. Recent publications have highlighted the potential for increased rates or likelihood of worsening glaucoma among those with larger IOP swings within defined time periods. The purpose of this systematic, comprehensive review and analysis of the literature was to assess the state of knowledge in the area of IOP changes over time and the potential impact of such changes on treatment. Current literature indicates that a random IOP measurement is a poor surrogate for IOP levels throughout the day and across visits. We address several key questions: 1) What is the best way to measure IOP? 2) Should multiple IOP measurements be performed in a day in the office (short-term IOP fluctuation)? 3) Is measurement at night required? 4) Should clinicians begin to assess long-term IOP fluctuation in patients under stable treatment (across days or visits)? and 5) Should therapy choices be influenced by properties of different treatment options relative to short- or long-term IOP fluctuation?
青光眼是导致视力损害和失明的主要原因之一。降低眼压(IOP)是在青光眼高风险人群以及早期至中度或更晚期青光眼患者中减缓或阻止疾病进展的唯一已证实方法。最近的出版物强调了在规定时间段内眼压波动较大的人群中青光眼病情恶化率增加或可能性增加的潜在风险。本系统、全面的文献综述和分析旨在评估眼压随时间变化领域的知识现状以及此类变化对治疗的潜在影响。当前文献表明,随机眼压测量不能很好地代表全天及各次就诊时的眼压水平。我们探讨了几个关键问题:1)测量眼压的最佳方法是什么?2)是否应在诊室一天内进行多次眼压测量(短期眼压波动)?3)是否需要在夜间测量?4)临床医生是否应开始评估稳定治疗患者的长期眼压波动(跨天或跨次就诊)?以及5)治疗选择是否应受不同治疗方案相对于短期或长期眼压波动特性的影响?