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Background <p>Intraocular pressure (IOP) reduction is the only proven method to arrest or slow down the progression of glaucoma to blindness. Single office IOP measurements that appear to be within the target pressure can be misleading, as some of these patients go ahead to develop progression in glaucoma, which may be due to a wide diurnal variation in IOP. Studies have shown a difference in the levels of IOP fluctuation between medically and surgically treated patients which may explain why some patients continue to deteriorate visually even though office IOP levels seem within target. The aim of this study was to compare the effect of medical treatment and trabeculectomy on IOP peaks and fluctuations among open-angle glaucoma patients in a Nigerian tertiary eye care centre.</p> Methods <p>This was a prospective, observational, nonrandomized comparative clinical study conducted on thirty-five eyes of 35 patients on medical therapy and thirty-two eyes of 32 patients who underwent surgical treatment at the University of Ilorin Teaching Hospital (UITH) between January and April 2024. The water drinking test (WDT) was performed on all participants after a 3-hour liquid fast. Intraocular pressure was measured at baseline and every 15&#xa0;min after water ingestion over 1&#xa0;h. Outcome measures were the peak IOP, trough IOP, IOP fluctuation (Peak IOP – baseline IOP), and the time to peak IOP.</p> Results <p>The mean baseline IOP before either instituting IOP-lowering medications or surgical treatment was similar in both groups (P value 0.62). However, significant differences in IOP values were observed in response to the Water Drinking Test (WDT) across all time points (baseline, 15&#xa0;min, 30&#xa0;min, 45&#xa0;min, and 60&#xa0;min), with the medical group consistently showing higher mean IOP values and more pronounced fluctuations compared to the surgical group (P values 0.001). The peak IOP occurred primarily at 30&#xa0;min post-WDT for most participants.</p> Conclusion <p>Trabeculectomy offers consistent and effective 24-hour IOP control, resulting in lower mean IOP, reduced peak IOP, and smaller IOP fluctuations throughout the day, compared to medical treatment, which is critical in preventing glaucoma progression.</p>

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Effect of medical and surgical therapy on intraocular pressure fluctuations among glaucoma patients in the University of Ilorin Teaching Hospital: A comparative clinical study

  • 期刊论文

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  • 发表日期：

    2026年1月22日

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  • Tokunbo Sarah Obajolowo,
  • Ibrahim Abiodun Yusuf,
  • Ambali Olamilekan Ambali,
  • Biola Toibat Tota-Bolarinwa,
  • Azeezat Bola Aderounmu,
  • Fatai Olasunkanmi Olatunji

摘要

Background

Intraocular pressure (IOP) reduction is the only proven method to arrest or slow down the progression of glaucoma to blindness. Single office IOP measurements that appear to be within the target pressure can be misleading, as some of these patients go ahead to develop progression in glaucoma, which may be due to a wide diurnal variation in IOP. Studies have shown a difference in the levels of IOP fluctuation between medically and surgically treated patients which may explain why some patients continue to deteriorate visually even though office IOP levels seem within target. The aim of this study was to compare the effect of medical treatment and trabeculectomy on IOP peaks and fluctuations among open-angle glaucoma patients in a Nigerian tertiary eye care centre.

Methods

This was a prospective, observational, nonrandomized comparative clinical study conducted on thirty-five eyes of 35 patients on medical therapy and thirty-two eyes of 32 patients who underwent surgical treatment at the University of Ilorin Teaching Hospital (UITH) between January and April 2024. The water drinking test (WDT) was performed on all participants after a 3-hour liquid fast. Intraocular pressure was measured at baseline and every 15 min after water ingestion over 1 h. Outcome measures were the peak IOP, trough IOP, IOP fluctuation (Peak IOP – baseline IOP), and the time to peak IOP.

Results

The mean baseline IOP before either instituting IOP-lowering medications or surgical treatment was similar in both groups (P value 0.62). However, significant differences in IOP values were observed in response to the Water Drinking Test (WDT) across all time points (baseline, 15 min, 30 min, 45 min, and 60 min), with the medical group consistently showing higher mean IOP values and more pronounced fluctuations compared to the surgical group (P values 0.001). The peak IOP occurred primarily at 30 min post-WDT for most participants.

Conclusion

Trabeculectomy offers consistent and effective 24-hour IOP control, resulting in lower mean IOP, reduced peak IOP, and smaller IOP fluctuations throughout the day, compared to medical treatment, which is critical in preventing glaucoma progression.