title: Large diurnal variation of intraocular pressure despite maximal medical treatment in juvenile open angle glaucoma.
abstract: OBJECTIVE
  To report the clinical significance of large fluctuations in intraocular pressure (IOP) and the effect of trabeculectomy on diurnal IOP variations in 2 cases of maximally medically treated juvenile open angle glaucoma (JOAG).
  
  
  METHODS
  A 24-hour IOP monitoring was performed before and after trabeculectomy on both eyes of 2 JOAG patients-one with transiently blurred vision early in the morning, the other with progression of visual field defect despite apparently well-controlled IOP. The patients' optic discs were scanned with Heidelberg retina tomograph (HRT) during peak and trough IOPs before trabeculectomy.
  
  
  RESULTS
  Preoperatively, diurnal IOP varied widely up to 20/19 (OD/OS) mm Hg in case 1 and up to 16/22 (OD/OS) mm Hg in case 2, even though both patients were using 4 different types of antiglaucoma eye drops. Peak IOP was associated with temporary blurring of vision and mild corneal edema in 1 patient (case 1). Heidelberg retina tomograph revealed a deepening of the optic cup and a resultant narrowing of the neuroretinal rim at peak IOP in this patient; this was not detected in the second patient who had tilted optic discs. After trabeculectomy, diurnal IOP fluctuations were reduced to 4-6/2-4 (OD/OS) mm Hg in case 1 and to 6-7/3-7 (OD/OS) mm Hg in case 2, with a decrease in peak IOPs as well.
  
  
  CONCLUSIONS
  Wide diurnal variation should be suspected in JOAG patients, even when receiving maximal medical treatment; this is especially important in cases with temporary blurred vision and/or progression of visual field defect despite apparently well-controlled IOP. Trabeculectomy was more effective in reducing diurnal IOP variation than medical treatment.
authors.affiliation: Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Sung Chul
authors.initials: SC
authors.lastname: Park
authors.forename: Changwon
authors.initials: C
authors.lastname: Kee
mesh_terms: D000328:Adult; D001794:Blood Pressure; D002940:Circadian Rhythm / Q000502:physiology*; D005260:Female; D005902:Glaucoma, Open-Angle / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology*; D009898:Optic Disk / Q000473:pathology; D014130:Trabeculectomy; D014786:Vision Disorders / Q000503:physiopathology