Effect of timolol on the diurnal intraocular pressure in exfoliation and primary open-angle glaucoma.
OBJECTIVE
To describe and compare the diurnal intraocular pressure (IOP) variation in patients with exfoliation glaucoma (EXG) and primary open-angle glaucoma (POAG) who were treated with a solution of timolol maleate (0.5%) twice daily.


METHODS
Consecutive Greek patients who were newly diagnosed as having EXG or POAG were prospectively investigated; they underwent 24-hour diurnal IOP measurements first without therapy and then 6 months afterward while they were being treated with timolol maleate (0.5%). After matching for age, 38 pairs of patients with these 2 types of glaucoma were compared.


RESULTS
Untreated patients with EXG had significantly higher IOP values for all time points assessed and a greater mean range of IOPs (11.8 mm Hg for EXG vs 7.6 mm Hg for POAG; P < or = .001). Following therapy with timolol maleate (0.5%) given twice daily, patients with EXG had higher IOP values for the measurements that were obtained at 6 and 10 AM, 10 PM, and 2 AM, a higher mean range of IOPs (7.0 mm Hg for EXG vs 5.6 mm Hg for POAG; P = .03), and a higher maximum IOP (mean, 24.9 mm Hg for EXG vs 20.9 mm Hg for POAG; P = .003). The reduction of the range of diurnal variation of IOP was more pronounced in patients with EXG than in patients with POAG (40% vs 26%; P = .04). Twenty-two (58%) of 38 patients with EXG and 20 (53%) of 38 patients with POAG had peak IOP values that were found outside office hours. Only 5 (13%) of the patients with EXG exhibited an IOP of 18 mm Hg or less at all time points compared with 12 (32%) of the patients with POAG (P = .05).


CONCLUSIONS
Despite a greater initial IOP reduction in the patients with EXG treated with timolol, a higher IOP and significant fluctuation in the diurnal curve of IOP during the time in which patients received therapy still characterized EXG from POAG.
Konstas
A G
AG
University Department of Ophthalmology, AHEPA Hospital, Thessaloniki Greece.
Mantziris
D A
DA
Cate
E A
EA
Stewart
W C
WC
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D002940:Circadian Rhythm / Q000187:drug effects / Q000502:physiology*; D017889:Exfoliation Syndrome / Q000150:complications*; D005260:Female; D005902:Glaucoma, Open-Angle / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions; D011446:Prospective Studies; D013999:Timolol / Q000627:therapeutic use*
D000319:Adrenergic beta-Antagonists; D009883:Ophthalmic Solutions; D013999:Timolol