Effect of timolol on the diurnal intraocular pressure in exfoliation and primary open-angle glaucoma
A. G. Konstas, D. A. Mantziris, E. A. Cate and W. C. Stewart
University Department of Ophthalmology, AHEPA Hospital, Thessaloniki Greece.
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. DESIGN: 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). CONCLUSION: 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.
