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Rebound, applanation, and dynamic contour tonometry in pathologic corneas.

André Rosentreter1, Apostolos Athanasopoulos, Andrea M Schild

  • 1Center for Ophthalmology, University of Cologne, Cologne, Germany. andre.rosentreter@googlemail.com

Cornea
|June 8, 2012
PubMed
Summary

The Icare rebound tonometer (RT) successfully measured intraocular pressure (IOP) in all pathologic corneas, unlike the Goldmann applanation tonometer (GAT) and Pascal dynamic contour tonometer (DCT). However, RT significantly underestimated IOP compared to GAT and DCT.

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Area of Science:

  • Ophthalmology
  • Biomedical Engineering

Background:

  • Accurate intraocular pressure (IOP) measurement is crucial for diagnosing and managing glaucoma.
  • Corneal abnormalities can significantly impact the accuracy of various tonometry methods.
  • The Icare rebound tonometer (RT), Goldmann applanation tonometer (GAT), and Pascal dynamic contour tonometer (DCT) are commonly used for IOP assessment.

Purpose of the Study:

  • To compare the practicability of RT versus GAT and DCT for IOP measurement in eyes with corneal abnormalities.
  • To investigate the influence of central corneal thickness, corneal diameter, corneal radius, and axial length on IOP measurements.
  • To evaluate the agreement between RT, GAT, and DCT in pathologic corneas.

Main Methods:

  • A study involving 171 pathologic eyes with corneal abnormalities and 26 nonpathologic control eyes from 99 patients.

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  • Pathologic corneas were categorized into subgroups: previous keratoplasty, keratoconus, corneal scars, corneal dystrophies, and bullous keratopathy.
  • IOP was measured using RT, GAT, and DCT, with subsequent correlation and Bland-Altman analyses.

    • Main Results:

    • RT achieved successful IOP measurements in all pathologic eyes, while GAT succeeded in 98.2% and DCT in 73.1%.
    • Mean IOP readings were 12.7 ± 4.1 mm Hg (RT), 15.5 ± 4.4 mm Hg (GAT), and 16.3 ± 4.1 mm Hg (DCT).
    • RT showed moderate correlation with GAT (r=0.566) and DCT (r=0.364), but revealed significant underestimation of IOP with wide limits of agreement.

    Conclusions:

    • RT is a practical tool for IOP measurement in eyes with corneal abnormalities where GAT and DCT may fail.
    • RT significantly underestimates IOP compared to GAT and DCT across all patient groups.
    • The agreement between RT and other tonometers is clinically acceptable for corneal dystrophy and keratoconus but poor after keratoplasty.