Glokom erken tanısında dinamik kontur tonometrenin yeri
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Date
2007
Authors
Atasoy, Aydın
Journal Title
Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
Amaç: Dinamik kontur tonometre (DKT) ile yapılan göz içi basıncı (GİB) ölçümlerini, Goldmann aplanasyon tonometresi (GAT) ölçümleri ile karşılaştırmak; merkezi kornea kalınlığı (MKK), kornea eğriliği (KE), ön kamara derinliği (ÖKD) ve yaşın GİB ölçümlerine etkisini araştırmak. DKT nin glokom tanısındaki yerini ve klinik pratiğini değerlendirmek. Gereç ve Yöntem: Kasım 2005 ile Temmuz 2007 tarihleri arasında 70 sağlıklı olgunun (32E, 38K, yaş ortalaması 52±7 yıl) 140 gözü glokom riski açısından çalışma kapsamına alındı. Hiçbir hastada, GİB ölçümlerini etkileyebilecek korneal patoloji, glokom tanısı, diyabet ve hipertansiyon gibi sistemik hastalık yoktu. Tüm gözlere Pentacam’la MKK, KE, ÖKD ölçümünü takiben sırasıyla GAT ve DKT ile GİB ölçümü yapıldı. MKK, KE, ÖKD ve yaşın GİB ölçümlerine etkisi araştırıldı. GAT ve DKT ölçümleri arasındaki uyumluluk Blandt-Altman yöntemiyle, GİB ölçümleri ve oküler nabız amplitüdü (ONA) ile diğer değişkenler arasındaki ilişkiler lineer regresyon analizleriyle değerlendirildi. Bulgular: Heriki cihazla ölçülen GİB değerleri arasında güçlü ilişki saptandı (r=0.572, P<0.001). DKT ölçümleri, GAT ölçümlerinden ortalama 0.46±2.55 mmHg daha yüksek saptandı, ancak bu fark istatistiksel olarak anlamlı değildi (p=0.139). BlandAltman grafisinde iki yöntem arasında makul uyumluluk saptandı (%95 uyumluluk sınırları; −5.46 ile +4,54 mmHg). GAT ölçümleri MKK’dan anlamlı derecede etkilenirken (p< 0,001), DKT ölçümleri etkilenmedi (p=0.860). GAT’ın aksine, DKT ölçümleri yaş (p=0.005) ve KE (p=0.016) ile anlamlı ilşki gösterdi. Gerek GAT, gerekse DKT ölçümleri ÖKD ile anlamlı bir ilişki göstermedi. GİB ortalamasındaki artış ile ONA’da anlamlı artış gözlendi (p<0.001). Sonuç: DKT’nin farklı kornea kalınlıklarına sahip gözlerde GİB ölçümünde, glokomun erken tanısı ve takibinde GAT’a göre daha güvenilir ve faydalı olabileceği düşünülmüştür.
Purpose: To compare the intraocular pressure (IOP) measurements taken with dynamic contour tonometer (DCT) and the Goldmann aplanation tonometer (GAT) and to evaluate the effect of central corneal thickness (CCT), corneal curvature (CC), anterior chamber depth (ACD) and age on İOP measurements. To evaluate the role of the DCT in diagnosis of glaucoma and clinical practice. Materials and Methods: 140 eyes of 70 healthy patients (32 males, 38 females, mean 52±7 year) who were examined between November 2005 and July 2007 were included in this study with respect to glaucoma risc. None of patients had corneal pathology, glaucoma diagnosis, and sistemic disease including diabetes mellitus and hipertension. All eyes underwent CCT, CC, ACD measurement with Pentacam device, and IOP measurement with GAT and Pascal DCT in random order. The effects of CCT, CC, ACD and age on IOP readings were analysed. The agreement between GAT and DCT readings was assessed using the Bland−Altman method. The effect of ocular variables on IOP measurements and ocular pulse amplitude (OPA) was assessed by linear regression analyses.Results: IOP measured by the two instruments correlated significantly (r=0.572, P<0.001). Mean DCT values were about 0.46±2.55 mmHg higher than GAT readings, but the difference was not significant (p=0.139). Bland-Altman scatterplot showed reasonable inter-method agreement between DCT and GAT measurements (%95 limits of agreement −5.46 to +4,54 mmHg). GAT measurements were significantly influenced by CCT (p< 0,001) whereas DCT measurements were not (p=0.860). Unlike GAT, DCT was affected by age and CC. Neither GAT nor DCT showed a significant correlation with ACD. With higher mean IOP values OPA tended to be larger (p<0.001).Conclusion: DCT seems to be more reliable method for IOP measurement in patients with different CCT, and more suitable and useful in early detection and follow-up of glaucoma than GAT.
Purpose: To compare the intraocular pressure (IOP) measurements taken with dynamic contour tonometer (DCT) and the Goldmann aplanation tonometer (GAT) and to evaluate the effect of central corneal thickness (CCT), corneal curvature (CC), anterior chamber depth (ACD) and age on İOP measurements. To evaluate the role of the DCT in diagnosis of glaucoma and clinical practice. Materials and Methods: 140 eyes of 70 healthy patients (32 males, 38 females, mean 52±7 year) who were examined between November 2005 and July 2007 were included in this study with respect to glaucoma risc. None of patients had corneal pathology, glaucoma diagnosis, and sistemic disease including diabetes mellitus and hipertension. All eyes underwent CCT, CC, ACD measurement with Pentacam device, and IOP measurement with GAT and Pascal DCT in random order. The effects of CCT, CC, ACD and age on IOP readings were analysed. The agreement between GAT and DCT readings was assessed using the Bland−Altman method. The effect of ocular variables on IOP measurements and ocular pulse amplitude (OPA) was assessed by linear regression analyses.Results: IOP measured by the two instruments correlated significantly (r=0.572, P<0.001). Mean DCT values were about 0.46±2.55 mmHg higher than GAT readings, but the difference was not significant (p=0.139). Bland-Altman scatterplot showed reasonable inter-method agreement between DCT and GAT measurements (%95 limits of agreement −5.46 to +4,54 mmHg). GAT measurements were significantly influenced by CCT (p< 0,001) whereas DCT measurements were not (p=0.860). Unlike GAT, DCT was affected by age and CC. Neither GAT nor DCT showed a significant correlation with ACD. With higher mean IOP values OPA tended to be larger (p<0.001).Conclusion: DCT seems to be more reliable method for IOP measurement in patients with different CCT, and more suitable and useful in early detection and follow-up of glaucoma than GAT.
Description
Keywords
Göz içi basıncı, Goldman aplanasyon tonometresi, Pascal dinamik kontur tonometre, Merkezi kornea kalınlığı, Kornea eğriliği, Intraocular pressure, Goldmann applanation tonometry, Pascal dinamic contour tonometry, Central corneal thickness, Corneal curvature
Citation
Atasoy, A. (2007). Glokom erken tanısında dinamik kontur tonometrenin yeri. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.