title: Dampening of diurnal intraocular pressure fluctuation by combined trabeculotomy and sinusotomy in eyes with open-angle glaucoma.
abstract: OBJECTIVE
  Large diurnal intraocular pressure (IOP) fluctuation ([INCREMENT]IOP) is believed to be one of the causes of progression in glaucomatous changes. Some fully medicated glaucoma patients whose IOPs are controlled during the regular office hours (10:00 to 16:00 h) still have progression in glaucomatous changes and IOP elevation during off-office hours. The purpose of this study was to determine whether [INCREMENT]IOP is dampened after combined trabeculotomy and sinusotomy (LOT+SIN) in glaucoma patients with low IOPs during the regular office hours.
  
  
  METHODS
  Fourteen eyes of 8 open-angle glaucoma patients who had large [INCREMENT]IOP despite low IOPs during the office hours were studied. The IOP was measured every 3 hours for 24 hours before and >3 months after the operation. The IOPs were measured in the sitting position with a Goldmann applanation tonometer. All patients underwent LOT+SIN.
  
  
  RESULTS
  All patients had IOP elevations >20 mm Hg between 0:00 and 3:00 hours before the operation, and none had an IOP peak after the operation. The postoperative mean IOP (16.5±1.7 to 13.9±2.0 mm Hg, P=0.00064), the maximum IOP (21.9±2.4 to 16.1±2.5 mm Hg, P=0.0020), and [INCREMENT]IOP (8.9±2.7 to 4.3±1.2 mm Hg, P=0.0032) were significantly lower than the preoperative values. However, the minimum IOP was not reduced significantly (13.0±1.9 to 11.7±1.7 mm Hg).
  
  
  CONCLUSIONS
  The diurnal [INCREMENT]IOPs are dampened by LOT+SIN in glaucoma patients with controlled IOPs during regular office hours. These results indicate that these surgical procedures can be used for the treatment of open-angle glaucoma patients.
authors.affiliation: Department of Ophthalmology, Kansai Medical University, Takii Hospital, Osaka, Japan. matsuokm@takii.kmu.ac.jp
authors.forename: Masato
authors.initials: M
authors.lastname: Matsuoka
authors.forename: Akira
authors.initials: A
authors.lastname: Ando
authors.forename: Keizo
authors.initials: K
authors.lastname: Minamino
authors.forename: Kayako
authors.initials: K
authors.lastname: Matsuyama
authors.forename: Chieko
authors.initials: C
authors.lastname: Shima
authors.forename: Miyo
authors.initials: M
authors.lastname: Matsumura
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Nishimura
mesh_terms: D000368:Aged; D000869:Anterior Eye Segment / Q000601:surgery*; D002940:Circadian Rhythm / Q000502:physiology*; D017889:Exfoliation Syndrome / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005902:Glaucoma, Open-Angle / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D012590:Sclera / Q000601:surgery; D014065:Tonometry, Ocular; D014130:Trabeculectomy