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Intraocular Pressure Measurement in Childhood Glaucoma under Standardized General Anaesthesia: The Prospective EyeBIS

Alicja Strzalkowska1, Nina Pirlich2, Julia V Stingl1

  • 1Department of Ophthalmology, University Medical Centre of the Johannes Gutenberg, University Mainz, 55131 Mainz, Germany.

Journal of Clinical Medicine
|May 28, 2022
PubMed

Insights

The iCare PRO rebound tonometer consistently measures higher intraocular pressure (IOP) than the Perkins applanation tonometer in both childhood glaucoma patients and healthy children. This difference was observed regardless of anesthesia depth or duration, highlighting a key consideration for IOP assessment in pediatric eye care.

Area of Science:

  • Ophthalmology
  • Pediatric Ophthalmology
  • Medical Devices

Background:

  • Accurate intraocular pressure (IOP) measurement is crucial for diagnosing and managing childhood glaucoma.
  • Different tonometry devices may yield varying IOP readings, particularly in pediatric populations.
  • The influence of anesthesia depth and duration on IOP measurements in children requires further investigation.

Purpose of the Study:

  • To compare IOP measurements between iCare PRO rebound tonometry and Perkins applanation tonometry in children.
  • To evaluate the impact of anesthesia depth, age, and corneal thickness on IOP readings from both devices.
  • To assess the agreement between iCare and Perkins tonometry in pediatric glaucoma subjects and healthy controls.

Main Methods:

  • Prospective clinical, case-control study involving 53 children with glaucoma and 22 healthy children undergoing general anesthesia.
  • IOP measurements were taken three times (T1-T3) using both iCare PRO and Perkins tonometry, with alternating measurement order.
  • Bland-Altman analysis was employed to assess the agreement between the two tonometry devices.

Main Results:

  • Both iCare and Perkins tonometry showed statistically significantly higher IOP in glaucoma subjects compared to healthy controls.
  • The iCare PRO consistently yielded higher median IOP readings than the Perkins tonometer in both groups (p < 0.001).
  • The mean IOP difference between iCare and Perkins ranged from 4.9 to 7.3 mmHg, indicating a systematic overestimation by iCare.

Conclusions:

  • The iCare PRO rebound tonometer demonstrates a systematic overestimation of IOP compared to the Perkins applanation tonometer in children.
  • IOP readings were highest at T1 (under sedation) for both devices and in both subject groups.
  • These findings suggest that clinicians should be aware of the device-specific differences when interpreting IOP measurements in pediatric patients.

Keywords:
Perkins tonometrychildhood glaucomaiCare tonometryintraocular pressure measurementstandardized anaesthesia

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