To investigate whether intraocular pressure (IOP) fluctuation is associated independently with the rate of visual field (VF) progression in the United Kingdom Glaucoma Treatment Study. Randomized, double-masked, placebo-controlled multicenter trial. Participants with ≥5 VFs (213 placebo, 217 treatment). Associations between IOP metrics and VF progression rates (mean deviation [MD] and five fastest locations) were assessed with linear mixed models. Fluctuation variables were mean Pascal ocular pulse amplitude (OPA), standard deviation (SD) of diurnal Goldmann IOP (diurnal fluctuation), and SD of Goldmann IOP at all visits (long-term fluctuation). Fluctuation values were normalized for mean IOP to make them independent from the mean IOP. Correlated nonfluctuation IOP metrics (baseline, peak, mean, supine, and peak phasing IOP) were combined with principal component analysis, and principal component 1 (PC1) was included as a covariate. Interactions between covariates and time from baseline modeled the effect of the variables on VF rates. Analyses were conducted separately in the two treatment arms. Associations between IOP fluctuation metrics and rates of MD and the five fastest test locations. In the placebo arm, only PC1 was associated significantly with the MD rate (estimate, –0.19 dB/year [standard error (SE), 0.04 dB/year]; < 0.001), whereas normalized IOP fluctuation metrics were not. No variable was associated significantly with MD rates in the treatment arm. For the fastest five locations in the placebo group, PC1 (estimate, –0.58 dB/year [SE, 0.16 dB/year]; < 0.001), central corneal thickness (estimate, 0.26 dB/year [SE, 0.10 dB/year] for 10 μm thicker; = 0.01) and normalized OPA (estimate, –3.50 dB/year [SE, 1.04 dB/year]; = 0.001) were associated with rates of progression; normalized diurnal and long-term IOP fluctuations were not. In the treatment group, only PC1 (estimate, –0.27 dB/year [SE, 0.12 dB/year]; = 0.028) was associated with the rates of progression. No evidence supports that either diurnal or long-term IOP fluctuation, as measured in clinical practice, are independent factors for glaucoma progression; other aspects of IOP, including mean IOP and peak IOP, may be more informative. Ocular pulse amplitude may be an independent factor for faster glaucoma progression. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

中文翻译：

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英国青光眼治疗研究中眼压波动与视野进展率的关系

在英国青光眼治疗研究中探讨眼压 (IOP) 波动是否与视野 (VF) 进展率独立相关。随机、双盲、安慰剂对照多中心试验。 VF ≥5 次的参与者（213 名安慰剂，217 名治疗组）。使用线性混合模型评估 IOP 指标和 VF 进展率（平均偏差 [MD] 和五个最快位置）之间的关联。波动变量是平均帕斯卡眼脉冲幅度（OPA）、每日Goldmann IOP（每日波动）的标准差（SD）以及所有就诊时Goldmann IOP的SD（长期波动）。对平均 IOP 的波动值进行标准化，使其独立于平均 IOP。将相关的非波动 IOP 指标（基线、峰值、平均、仰卧和峰值相位 IOP）与主成分分析相结合，并将主成分 1 (PC1) 作为协变量纳入其中。协变量和距基线的时间之间的相互作用模拟了变量对心室颤动率的影响。在两个治疗组中分别进行分析。 IOP 波动指标与 MD 速率和五个最快测试位置之间的关联。在安慰剂组中，只有 PC1 与 MD 率显着相关（估计值 –0.19 dB/年 [标准误差 (SE)，0.04 dB/年]；< 0.001），而标准化 IOP 波动指标则不然。治疗组中没有变量与 MD 发生率显着相关。对于安慰剂组中最快的五个位置，PC1（估计值，–0.58 dB/年 [SE，0.16 dB/年]；< 0.001），中央角膜厚度（估计值，0.26 dB/年 [SE，0.10 dB/年] 10 μm 厚；= 0.01）和标准化 OPA（估计值，–3.50 dB/年 [SE，1.04 dB/年]；= 0.001）与进展率相关；标准化的昼夜和长期眼压波动则不然。在治疗组中，只有 PC1（估计值 –0.27 dB/年 [SE，0.12 dB/年]；= 0.028）与进展率相关。没有证据支持临床实践中测量的每日或长期眼压波动是青光眼进展的独立因素； IOP 的其他方面，包括平均 IOP 和峰值 IOP，可能提供更多信息。眼脉冲幅度可能是青光眼进展更快的独立因素。专有或商业披露可在本文末尾的脚注和披露中找到。