Einfluss des Geschlechtes auf den Augeninnendruck bei Patienten mit Glaukom

Is there a gender effect on the intraocular pressure in glaucoma patients? Methods: We analyzed 1058 24h circadian intraocular pressure (IOP) profiles taken in our clinic from 2013-2017. 1770 eyes from 885 patients could be included in the analysis matching the inclusion criteria. 60% were female. 37% of the patients were affected with primary open-angle glaucoma (OWG), 16% with pseudoexfoliation glaucoma (PEXG), 11% with pigmentary glaucoma (PG), 10% with normal-tension glaucoma (NDG), 15% with suspected glaucoma (Exc/GV), 5% with ocular hypertension, 3% healthy, and 1% with other problems. Collected and analyzed data were circadian IOP values (mm Hg), age (years), pachymetry (µm), medical and surgical antiglaucoma treatments, stage of glaucoma (white-on-white perimetry defects), target IOP (mm Hg), and proposed therapy. To compare the corresponding data the arithmetical mean value was generated. Regarding the intraocular pressure the arithmetical mean value of all IOP measurements (IOD), the arithmetical mean value of the fluctuations of the circadian IOP (IOD-Schwank), the arithmetical mean value of the maximum IOP (IOD-Max) and the arithmetical mean value of the IOP at each time was compared gender-related. Furthermore, a multiple regression analysis between IOP and the factors age, antiglaucoma treatment, female gender, pseudophakia, trabeculectomy and cyclodestruction was performed. Results: Regarding age, pachymetry and previous operations of the eye there were only marginal differences between the genders. Women were minimally older (~1 year), more often with previous surgery and with advanced glaucoma but using less (~10%) topical antiglaucoma medication. The IOD of all measurements and the IOD-Max were lower in women than in men (IOD 13.4(F)<13.9(M) and IOD-Max 16.6(F)<17.0(M)). The IOP-fluctuations were equal between men and women. Focusing on all the patients with glaucoma (NDG; OWG, PEXG; PG) this IOP-difference would be even bigger and significant (IOD 13.1(F)<14.0(M) and Ø IOD-Max 16.2(F)<17.2(M)). The largest group of patients suffering from primary chronic open-angle glaucoma showed the greatest and clinically significant IOP-difference in IOD and IOD-Max (IOD 13.1(F)<14.3(M) and IOD-Max 16.2(F)<17.4(M)). To rule out the effect of the previous IOP-reducing operations, that were more frequent in women, a sub-group analysis of these patients with no glaucoma operations in the past confirmed the same aspect. Patients with PG showed similar significant gender-related differences in IOD und IOD-Max, which were obvious lower and insignificant in patients with PEXG. Contrary to this, females with normal-tension glaucoma were at higher IOD and IOD-Max levels than males. Within the multiple regression analysis, the factor “female gender” could be identified as significant IOP lowering influence (approx. 1 mm Hg) on the IOD of OWG- and PG-patients. Discussion and Conclusion: Epidemiological studies among the normal population (patients with glaucoma <5%) regarding a gender-related IOP level could not prove a unified picture, but mostly the Ø IOP in women was minimally higher (< 0.3 mm Hg) than in men. There seem to be regional differences as well. Ophthalmological factors besides surgical and pharmacological treatment influencing the IOP are well known: distinctive anatomical features (myopia), corneal pachymetry and corneal rigidity. There were other studies that could prove systemic factors influencing the IOP, for example pregnancy, hormone concentration abnormalities in women and in particular the metabolic syndrome. These factors could explain signific IOP-differences, but within a normal distributed prevalence its influence is comparatively slight. We do not expect that the amount of the measured IOP-difference could be explained hereby. The strength of our study is the comparison between male and female patients with different types of glaucoma in the absence of major differences in the preconditions of the IOP (age, corneal thickness and therapy) and a very large number of participants. Indeed, we could finally prove that the intraocular pressure is higher (>1 mm Hg) in men than in women. This effect was particularly prominent in the largest patient group, those with chronic open angle glaucoma. To our best knowledge the selective analysis of patients with open-angle glaucoma within the “Barbados eye study” is the only one that could demonstrate an IOP-difference in people with glaucoma as well348.