Архив офтальмологии Украины Том 11, №2, 2023

В офтальмологічній літературі останнього десятиліття активно обговорюється роль офтальмобіометричних показників у формуванні офтальмотонуса. Взаємозв’язок порушень біомеханіки ока з розвитком деяких офтальмологічних захворювань стосується проміжної галузі знань і дотепер залишаться маловивченим. Проведені дослідження з порівняння рикошетної тонометрії з використанням тонометра іСare ІС200, апланаційної тонометрії з використанням тонометра Гольдмана, тонометра Маклакова та пневмотонометрії. Обстежено 372 ока (184 правих та 188 лівих) 194 пацієнтів. Встановлено, що рикошетна тонометрія безпечна і добре переноситься пацієнтами. Рикошетна тонометрія є надійною альтернативою апланаційній тонометрії Гольдмана на очах з еметропічною та міопічною рефракцією слабкого та середнього ступеня, більш ефективною у вимірюванні внутрішньоочного тиску порівняно з тонометрією Маклакова і пневмотонометрією. Однак у пацієнтів з міопією високого ступеня вимірювання, отримані з використанням рикошетної тонометрії, погано корелюють з апланаційною тонометрією Гольдмана.

Background. Accurate measurements of intraocular pressure (IOP) are key to diagnose a range of conditions, and especially to monitor glaucoma. Single studies are evidence of the intraocular pressure dependence on the central corneal thickness, corneal hysteresis, rigidity of the cornea and sclera, and other biomechani­cal indicators of the fibrous membrane of the eye. The obtained results are contradictory. Today, Goldmann applanation tonometer (GAT) remains the reference standard of tonometry. However, despite the identified advantages, it also has limitations. Recently, a new portable alternative to Goldmann applanation tonometry — rebound tonometry (RT) — has been actively introduced on the global ophthalmology market. The purpose of our study was to compare the results of intraocular pressure measurement using several tonometers: Goldmann applanation tonometer, Maklakov tonometer (MT), іСare tonometer and pneumotonometer (PT) in patients with emmetropia and myopia of various degrees. Materials and methods. One hundred and ninety-four patients (372 eyes) with emmetropia and myopic refraction of various degrees participated in the study. The gender and age characteristics were as follows: there were 95 men (48.97 %) and 99 women (51.03 %), whose average age was 25 ± 2 years. Patients with glaucoma, corneal scarring, corneal edema, after corneal surgery, and those with corneal astigmatism > 3.0 D were excluded from the study. All patients were informed about the purpose and course of the study and signed informed consent to participate in it. During the study, all patients underwent a comprehensive ophthalmological examination, which included: visometry, biomicroscopy, ophthalmoscopy, refractometry, ophthalmometry, biometry, pachymetry (Visante OCT, Zeiss), PT (Topcon, Japan), MT, GAT, RT (іСare ІС200). IOP was measured by three independent physicians who did not know the results of each other’s studies. When conducting the research, the principles of randomization were followed. Statistical data processing was carried out in Windows Microsoft Excel 2010 using SPSS 17.0 statistical software (Chicago, IL, USA). Results. The analysis of the results showed that the average IOP of 372 eyes determined by RT and GAT was 19.03 ± 4.83 mmHg and 19.29 ± 4.12 mmHg, respectively. RT readings were relatively lower than those obtained with GAT. However, their difference was not statistically significant (t = –1.29, p = 0.22). The Bland-Altman plot showed that the difference in measurements between PT and MT was –1.51 ± 3.71 mmHg, with a confidence level of 95 %. PT readings were 3.98 mmHg higher than those obtained using RT. In addition, only in 37.63 % of cases (140 eyes), the difference in IOP determined using RT and PT was ≤ ± 3 mmHg, and in 38.44 % (143 eyes), > ± 5 mmHg. The difference in the measured value of IOP using RT and GAT in emmetropic eyes was quite small and did not have statistical significance (t = 0.24, P = 0.80). However, in eyes with high myopia, RT values were lower than those obtained with GAT. The difference was statistically significant (t = –2.63, P = 0.005). Linear regression analysis showed that RT (r = 0.348, P = 0.001) and GAT (r = 0.189, P = 0.001) had a positive correlation with the degree of myopia. However, the influence of the latter on RT was higher than when measuring GAT. In addition, linear regression analysis showed that RT (r = 0.334, P = 0.001), MT (r = 0.532, P = 0.001), PT (r = 0.611, P = 0.001) and GAT (r = 0.186, P = 0.001) had a positive correlation with central corneal thickness. The effect of central corneal thickness on PT and MT indicators was higher than that on RT and GAT. Conclusions. It has been found that rebound tonometry is safe and well tolerated by patients. Rebound tonometry is a reliable alternative to Goldmann applanation tonometry in eyes with mild to moderate emmetropic and myopic refraction, it is more effective in measuring IOP compared to MT and PT. However, in patients with high myopia, measurements obtained using RT poorly correlated with GAT. Further research is needed to determine the influence of biomechanical indicators of the cornea on the results of IOP measurement with different types of tonometry.

внутрішньоочний тиск; ригідність; рикошетна тонометрія; апланаційна тонометрія Гольдмана; тонометрія Маклакова; пневмотонометрія

intraocular pressure; rigidity; rebound tonometry; Goldmann applanation tonometry; Maklakov tonometry; pneumotonometry

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