Yasuaki Kuwayama, MD, Ph.D.

Osaka Koseinenkin Hospital

What kind of impact does trabeculectomy have on the variation of intraocular pressure (IOP)?  To evaluate the effect of trabeculectomy on circadian variations of intraocular pressure (IOP), we measured circadian IOP, every 3 hours over a 24-hours of period, pre-operatively under glaucoma medications within 1 month before operation, and post-operatively under no medication more than 3 months after operationin 19 eyes of 12 patients with normal tension glaucoma and primary open angle glaucoma.  Mean 24-hour IOP, maximum IOP, and minimum IOP before trabeculectomy (mean +/- standard deviation: 15.6 +/- 2.4 mm Hg, 19.3 +/- 3.0 mmHg, 12.2 +/- 2.5 mmHg, respectively) decreased after trabeculectomy (10.0 +/- 3.3 mmHg, 12.0 +/- 4.2 mmHg, 8.1 +/- 3.0 mmHg, respectively).  All changes were statistically significant (p<0.0001).  The range of IOP fluctuations also reduced significantly after trabeculectomy (7.1 +/- 2.3 mmHg to 3.9 +/- 2.4 mmHg; p<0.0001).It is still unclear which is the more important causative factor for the development and progression of glaucoma, maximum IOP or fluctuation of IOP.  However, trabeculectomy not only reduce IOP but also flatten circadian IOP.

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