Wilensky J T, Gieser D K, Dietsche M L, Mori M T, Zeimer R
Department of Ophthalmology and Visual Sciences, University of Illinois, Chicago College of Medicine 60612.
Ophthalmology. 1993 Jun;100(6):940-4. doi: 10.1016/s0161-6420(93)31551-4.
Reduction of intraocular pressure (IOP) is a primary goal of most glaucoma treatments. However, because the IOP varies during the day, single measurements performed in an ophthalmologist's office do not necessarily provide information on the peak level and fluctuation of the IOP.
Home tonometry was performed to gain more information on the nature of the diurnal IOP curves and on their variability. One hundred seventy-six patients with open-angle glaucoma (OAG), 55 subjects with ocular hypertension (OHT), and 18 control individuals measured their IOP five times daily at home for 4 to 8 consecutive days using a self-tonometer.
Well-defined diurnal IOP variations were observed in all three groups with a predominance of curves with morning or mid-day maxima. Erratic IOP curves without a diurnal rhythm were present in OHT (22%) and OAG (16%) patients but not in control subjects. Differences between the curves of the two eyes of an individual were frequent in OHT (33%) and OAG (36%) patients but not in control subjects (6%). Finally, the majority of OHT (72%) and OAG (66%) patients showed a difference in their diurnal curve patterns on repeat home tonometry performed months apart.
The authors indicate that it is difficult to rely on one eye as a control for the other. They also indicate that changes in IOP observed in the office at different visits often may be due to a shift in the type of diurnal curve rather than to a true change in the mean IOP. Monitoring of the diurnal IOP may be necessary in some cases if the clinician relies, even partially, on the level of IOP when making a decision on patient management.
降低眼压是大多数青光眼治疗的主要目标。然而，由于眼压在一天中会有所变化，在眼科医生办公室进行的单次测量不一定能提供有关眼压峰值水平和波动的信息。
进行家庭眼压测量以获取更多关于眼压日曲线特征及其变异性的信息。176例开角型青光眼（OAG）患者、55例高眼压症（OHT）患者和18名对照个体使用自眼压计在家中连续4至8天每天测量5次眼压。
在所有三组中均观察到明确的眼压日变化，以早晨或中午达到最大值的曲线为主。高眼压症（22%）和开角型青光眼（16%）患者中存在无昼夜节律的不稳定眼压曲线，而对照个体中则没有。高眼压症（33%）和开角型青光眼（36%）患者中个体双眼曲线之间的差异很常见，而对照个体中则不常见（6%）。最后，大多数高眼压症（72%）和开角型青光眼（66%）患者在相隔数月进行的重复家庭眼压测量中，其日曲线模式存在差异。
作者指出，很难将一只眼睛作为另一只眼睛的对照。他们还指出，在不同就诊时在办公室观察到的眼压变化通常可能是由于日曲线类型的转变，而不是平均眼压的真正变化。如果临床医生在对患者管理做出决策时，即使部分依赖眼压水平，在某些情况下可能有必要监测眼压日变化。
