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Hornhautdickenabhängige Korrekturfaktoren bei der Goldmann-Applanationstonometrie

Correction factors for central corneal thickness in Goldmann applanation tonometry

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Zusammenfassung

Hintergrund

Seit vielen Jahren wird diskutiert, welche kornealen Parameter die Messung des intraokularen Druckes (IOP) verfälschen können. Als wesentlicher Parameter wird die zentrale Hornhautdicke (CCT) angenommen, wobei unterschiedliche Meßmethoden (GAT: Goldmann-Applanationstonometrie, DCT: Dynamic-Contour-Tonometrie, IOPcc: korneal compensierter Druck, gemessen mit dem Ocular Response Analyser) ganz unterschiedliche Abhängigkeiten von der Hornhautdicke ergeben sollen.

Methode

Bei 92 Augen von Kataraktpatienten und 85 Augen von Glaukompatienten mit jeweils stark unterschiedlicher CCT wird im Rahmen einer von der Ethikkommission genehmigten Studie unmittelbar vor bulbuseröffnender Operation (Kataraktoperation oder Trabekelektomie) die Vorderkammer kanüliert und bei unterschiedlich eingestellten Druckniveaus (20 mmHg, 30 mmHg, 40 mmHg) die intraokular mit einem Druckaufnehmer gemessenen IOP-Werte (IOP) mit den simultan gemessenen GAT-Werten (Perkins-Tonometer) verglichen.

Ergebnisse

Die Einzelmessungen weisen eine außerordentlich hohe Streuung auf. Es ergeben sich in beiden Gruppen schwache Korrelationen der Differenz zwischen GAT und IOP mit der CCT. (Korrekturfaktoren von 0,95 mmHg/100 µm CCT bei Druckniveau 20 mmHg, 1,2 mmHg/100 µm CCT bei Druckniveau 30 mmHg und 1,7 mmHg/100 µm CCT bei Druckniveau 40 mmHg.)

Schlussfolgerungen

Die Messung der CCT ist für die prognostische Bewertung eines Glaukoms von Bedeutung, nicht jedoch für die Angabe hornhautdickenabhängiger Korrekturfaktoren für die GAT-Einzelmessung.

Abstract

Background

For many years researchers have discussed which corneal parameters can influence the measurement of intraocular pressure (IOP). As a substantial parameter, the central corneal thickness (CCT) is assumed; however, different measuring methods – including Goldmann applanation tonometry (GAT), dynamic contour tonometry (DCT), and corneal compensated pressure measured with the ocular response analyzer (IOPcc) – may lead to a completely different dependence on corneal thickness.

Method

In a study approved by the ethics commission, the anterior chamber of 92 eyes of cataract patients and 85 eyes of glaucoma patients with very different CCT measurements was cannulized before surgery (cataract operation or trabeculectomy), and the IOP values were measured simultaneously with a pressure absorber and with GAT (Perkins tonometer) at different pressure values.

Results

The individual measurements exhibited an extraordinarily wide dispersion. In both groups, weak correlations of the difference between GAT and IOP values with the CCT were found (correction factors of 0.95 mmHg/100 µm CCT at pressure level 20 mmHg, 1.2 mmHg/100 µm CCT at pressure level 30 mmHg, and 1.7 mmHg/100 µm CCT at pressure level 40 mmHg).

Conclusions

Measurement of CCT is valuable for prognostic assessment of glaucoma, but not for correction factors for corneal thickness.

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Der korrespondierende Autor weist auf folgende Beziehung/en hin: finanzielle Unterstützung durch die Fa. Alcon.

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Authors and Affiliations

  1. Abteilung für Augenheilkunde, Asklepios Klinik Nord Heidberg, Tangstedter Landstraße 400, 22417, Hamburg, Deutschland

    A. Kutschan, B. Schroeder, A. Hager, H. Dave & W. Wiegand

  2. Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland

    K. Wegscheider

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  1. A. Kutschan
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  2. B. Schroeder
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  3. A. Hager
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  4. H. Dave
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Correspondence to A. Kutschan.

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Kutschan, A., Schroeder, B., Hager, A. et al. Hornhautdickenabhängige Korrekturfaktoren bei der Goldmann-Applanationstonometrie. Ophthalmologe 107, 30–35 (2010). https://doi.org/10.1007/s00347-009-1926-0

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