Water-drinking Test and Pharmacologic Mydriasis as Provocative Tests in Primary Angle Closure Suspects

PURPOSE: To compare the water-drinking test (WDT) and pharmacologic mydriasis as provocative tests in patients with primary angle closure suspect (PACS). METHODS: This observational non-randomized comparative study evaluated changes in intraocular pressure (IOP) in 21 patients with PACS who underwent pharmacologic mydriasis and compared it with IOP changes in 26 patients given the WDT. Ocular biometric and anterior chamber parameters were also assessed. Tests were repeated on the same patient two weeks after performing laser peripheral iridotomy (LPI). RESULTS: The mean age [Formula: see text] standard deviation was 60 [Formula: see text] 7 and 57 [Formula: see text] 9 years in the mydriasis and WDT groups, respectively (P = 0.201). Before LPI, both provocative tests were associated with a significant increase in IOP (mydriasis: 15.1 [Formula: see text] 3.1 to 16.6 [Formula: see text] 3.5 mmHg, P = 0.025; WDT: 16.2 [Formula: see text] 2.8 to 18.5 [Formula: see text] 3.3 mmHg, P < 0.001). However, the IOP changes were not statistically different between groups (P = 0.102). After LPI, only the WDT group showed a continued significant IOP elevation after the test (mydriasis: 16.4 [Formula: see text] 3.3 to 16.7 [Formula: see text] 3.5 mmHg, P = 0.569; WDT: 14.9 [Formula: see text] 3.0 to 17.8 [Formula: see text] 4.1 mmHg, P < 0.001). The post-test IOP change was significantly greater in the WDT than in the mydriasis group (3.0 versus 0.3 mmHg, respectively; P = 0.002). Step-wise multiple regression analysis verified the type of provocative test as the only independent factor affecting the post-test IOP change after LPI (regression coefficient: 2.664; P = 0.002). CONCLUSION: Pharmacologic mydriasis and the WDT had similar IOP elevation before LPI, but after LPI, IOP elevation was much greater in the WDT group.