Objective: To investigate accuracy of the currently used strategies for intraocular pressure measurements for reflecting actual 24-hour intraocular pressure fluctuations.
Methods: From September, 2018 to January, 2019, the patients with a suspected diagnosis of primary open angle glaucoma at our hospital were prospectively enrolled to receive 24-hour intraocular pressure monitoring using a Goldmann tonometer. With the intraocular pressure measurements at 0:00, 2:00, 5:00, 7:00, 8:00, 10:00, 11:00, 14:00, 16:00, 18:00, 20:00, and 22:00 as the gold standard (strategy 1), we compared the measurements taken at 5:00, 7:00, 10:00, 14:00, 18:00, and 22:00 (strategy 2) and at 8:00, 11:00, 14:00, and 16:00 (strategy 3) for their accuracy in reflecting 24-h intraocular pressure fluctuations.
Results: A total of 41 patients (82 eyes) were enrolled in this study. The peak intraocular pressures measured using the 3 strategies were 21.09±4.15 mmHg, 20.54±4.10 mmHg, and 19.91±4.38 mmHg, respectively, showing significant differences among them (P < 0.05). The trough intraocular pressures measured by the 3 strategies were also significantly different (13.93±3.38 mmHg, 14.63±3.49 mmHg, and 15.46±3.63 mmHg, respectively; P < 0.05). The co-occurrence of the peak intraocular pressure was 74.39% between strategies 1 and 2 and 43.90% between strategies 1 and 3. The sensitivity of strategies 2 and 3 for detecting 24-h intraocular pressure fluctuations was 55.56% and 36.11%, respectively.
Conclusions: For suspected cases of glaucoma, intraocular pressure measurements at 4 and 6 time points of a day can not precisely reflect the actual range of intraocular pressure fluctuations, and may lead to a missed diagnosis of glaucoma.
目的: 分析目前临床上普遍采用的24 h眼压测量策略对于一日眼压波动的代表性。
方法: 纳入2018年9月~2019年1月，我院门诊诊断为“可疑青光眼”的患者，对其进行24 h眼压测量。测量时间点为：0:00，2:00，5:00，7:00，8:00，10:00，11:00，14:00，16:00，18:00，20:00，22:00，称为策略1。其中，5:00，7:00，10:00，14:00，18:00，22:00作为策略2的测量时间点；8:00，11:00，14:00，16:00作为策略3的测量时间点。分别将策略2和策略3与作为金标准的策略1进行比较。采用Goldmann压平眼压计由同一名测量者完成测量。
结果: 共纳入41例患者82眼。策略1、策略2和策略3的峰值眼压分别为：21.09±4.15 mmHg、20.54±4.10 mmHg和19.91±4.38 mmHg，差异有统计学意义（P < 0.05）；谷值眼压分别为：13.93±3.38 mmHg、14.63±3.49 mmHg和15.46±3.63 mmHg，差异有统计学意义（P < 0.05）。策略1和策略2峰值眼压的共现性为74.39%，策略1和策略3峰值眼压的共现性为43.90%。策略2和策略3对于发现24 h眼压波动幅度的敏感性分别为55.56%和36.11%。
结论: 对于可疑青光眼患者，一日4次或6次眼压测量无法精确的反映出眼压波动的幅度，容易造成漏诊。
Keywords: 24-hour intraocular pressure; clinical study; monitoring strategies; prospective study.