Jules Stein Eye Institute, The David Geffen School of Medicine, Los Angeles, California.
Doheny Eye Institute, University of Southern California, Los Angeles, California.
Am J Ophthalmol. 2011 Sep;152(3):340-344.e2. doi: 10.1016/j.ajo.2011.05.029.
To review the role of intervisit intraocular pressure (IOP) fluctuation as an independent risk factor for glaucoma.
Perspective after literature review.
Analysis of pertinent publications in the peer-reviewed literature.
Disparate findings regarding the role of intervisit IOP variation have been published. IOP variation was a significant risk factor in the Advanced Glaucoma Intervention Study (AGIS), the Collaborative Initial Glaucoma Treatment Study, and other smaller studies. These studies have in common low IOPs (often after surgery) and moderately advanced disease. In the AGIS, when patients were stratified by mean IOP, only those patients with low IOPs showed the detrimental effects of IOP variation. IOP variation was not a significant risk factor in the Early Manifest Glaucoma Treatment Trial, and in 2 separate studies of ocular hypertensives. These studies have in common generally higher IOPs and an earlier stage of glaucoma (or no glaucoma at all). We believe these results are complementary rather than contradictory: existing data suggest that the effects of IOP variation depend on the characteristics of the patient, the baseline IOP, their stage of damage, the type of glaucoma, and other as-yet unknown factors.
Practitioners should consider whether patients who are progressing at low mean IOP may benefit from having IOP variation reduced. Single elevated measures of IOP may not be an anomaly or may not be related to compliance, but may identify patients who are at high risk for progressive glaucomatous damage, and thus should be monitored more carefully and potentially treated more aggressively.
综述眼压波动作为青光眼独立危险因素的作用。
文献复习后的观点。
分析同行评议文献中的相关出版物。
关于眼压波动作用的不同研究结果。眼压波动是高级青光眼干预研究（AGIS）、合作性初始青光眼治疗研究和其他较小研究中的一个重要危险因素。这些研究的共同点是IOP 较低（通常在手术后）且疾病处于中度晚期。在 AGIS 中，当根据平均眼压对患者进行分层时，只有低眼压患者显示眼压波动的有害影响。眼压波动不是早期显性青光眼治疗试验和 2 项眼部高血压患者的独立研究中的危险因素。这些研究的共同点是一般较高的眼压和较早期的青光眼（或根本没有青光眼）。我们认为这些结果是互补的，而不是矛盾的：现有数据表明，眼压波动的影响取决于患者的特征、基础眼压、损伤阶段、青光眼类型和其他未知因素。
临床医生应考虑进展期低平均眼压患者是否可能受益于降低眼压波动。单次眼压升高可能不是异常，也可能与依从性无关，但可能会识别出具有进展性青光眼损伤高风险的患者，因此应更仔细地监测并可能更积极地治疗。
