Effects of the timolol-dorzolamide fixed combination and latanoprost on circadian diastolic ocular perfusion pressure in glaucoma.

PURPOSE. To evaluate the effect of the timolol-dorzolamide fixed combination (TDFC) and latanoprost 0.005% on 24-hour intraocular pressure (IOP), systolic (SBP) and diastolic (DBP) blood pressure, and diastolic ocular perfusion pressure (DOPP) in patients with primary open-angle glaucoma (POAG). METHODS. This was an institutional, randomized clinical trial. After a 24-hour assessment without treatment, 27 previously untreated patients with POAG were randomized to 6 weeks’ treatment with twice-daily TDFC (8 AM and 8 PM) followed by once-daily latanoprost 0.005% (8 PM), or vice versa. One eye was analyzed per patient. The mean values of IOP, DBP, SBP, and DOPP (difference between DBP and IOP) were recorded at each time point, and the 24-hour data are the mean values of each patient’s measurements over the 24-hour period. The differences between the values of the first treatment period and the baseline and the second treatment period and washout were calculated and analyzed by means of an analysis of variance model that tested the effects of sequence and treatment. RESULTS. Both treatments significantly reduced 24-hour IOP (P <0.0001), but TDFC led to lower 24-hour pressure (mean ±SD: 15.4 ±1.9 vs. 16.7± 1.7 mm Hg; P=0.004). Latanoprost did not lead to any significant reduction in mean 24-hour SBP and DBP (SBP: P =0.952; DBP: P=0.831), but TDFC did (SBP and DBP: P < 0.0001). Both treatments significantly increased 24-hour DOPP (P < 0.0001), with no difference between the two medications (P=0.09). CONCLUSIONS. In previously untreated patients with POAG, TDFC, and latanoprost equally enhanced 24-hour DOPP: the former by counteracting the decrease in DBP with a substantial reduction in IOP and the latter by not affecting DBP and significantly reducing IO

Untreated 24-Hour Intraocular Pressure Measured by Goldmann Applanation Tonometry Compared to Nightime Supine Pressures With Perkins&apos; Applanation Tonometry

Purpose:To use Perkins\u2019 applanation tonometry to measure supine nighttime intraocular pressures and to compare these values to sitting day and nighttime Goldmann applanation intraocular pressures. Methods:Prospective, untreated, uncontrolled, observational cohort. Qualified patients underwent an appropriate washout period of their current ocular hypotensive medications. Patients with pressures of 22 mm Hg at 10:00, in at least one eye, underwent pressure measurements over 24 hours at 10:00, 14:00, 18:00, 22:00, 02:00 and 06:00 by Goldmann applanation tonometry in a sitting position. In addition, patients had their pressures measured at 10:00, 22:00, 02:00 and 06:00 by Perkins\u2019 applanation tonometry in a supine position Results:In total, 100 patients completed the study. The mean intraocular pressures at 10:00, 22:00, 02:00 and 06:00, while sitting was 23.1\ub13.6 ,and in the supine position, 23.5\ub14.3 (P&lt;0.001). Further, the difference in pressure was significantly different between sitting and supine groups at 3 individual time points (10:00, 22:00, 02:00, P0.006) but not at 06:00 (P=0.30). Glaucoma patients (n=35) had a mean change of 22.7\ub13.5 to 23.6\ub14.0 mmHg, while ocular hypertensives (n=65) had a mean change of 22.5\ub13.6 to 23.4\ub14.4 mmHg, moving from a sitting to a supine position (P=0.07). The mean sitting Goldmann intraocular pressures across the three diurnal time points (10:00, 14:00 and 18:00) was 23.9\ub16.2 and across the three night time points (22:00, 02:00 and 06:00) was 21.4\ub10.2(P&lt;0.001). In contrast, the mean daytime sitting Goldmann pressures were not statistically different than nighttime supine Perkins\u2019 pressures (22.8\ub14.4,P=0.07). However, only 90% of patients were within 5.7 mmHg of the highest daytime reading for all nighttime supine and sitting pressures. Conclusions:This study suggests that by Goldmann applanation tonometry, untreated supine or sitting intraocular pressures are not higher at night than daytime sitting pressures. However, the highest daytime sitting pressures do not predict well the highest nighttime sitting or supine pressure values