Martinez-de-la-Casa Jose M, Garcia-Feijoo Julian, Vico Eva, Fernandez-Vidal Ana, Benitez del Castillo Jose M, Wasfi Mohamed, Garcia-Sanchez J
Hospital Clínico San Carlos and Instituto de Investigaciones Oftalmológicas Ramon Castroviejo, Universidad Complutense, Madrid, Spain.
Ophthalmology. 2006 Dec;113(12):2156-62. doi: 10.1016/j.ophtha.2006.06.016. Epub 2006 Sep 25.
To identify correlations among intraocular pressure (IOP) measurements obtained using the rebound tonometer (RBT), the dynamic contour tonometer (DCT), and the Goldmann applanation tonometer (GAT). The effects of corneal thickness on the measures obtained using each of the 3 tonometers also were examined.
Cross-sectional study.
One hundred forty-six eyes of 90 patients with ocular hypertension or glaucoma.
Intraocular pressure measurements were obtained in all patients using RBT, DCT, and GAT. Central corneal thickness was determined by ultrasound pachymetry. Patients were divided randomly into 6 groups to vary the order in which the tonometers were used. All IOP measurements were made by the same examiner, who was masked to the readings obtained.
Intraocular pressure and central corneal thickness.
There was good correlation between IOP readings obtained using the RBT and GAT (r = 0.864; P<0.0001), between DCT and GAT (r = 0.871; P<0.0001), and between RBT and DCT (r = 0.804; P<0.0001). Rebound tonometer and DCT readings consistently were higher than GAT measurements (RBT-GAT median difference, 1.4+/-2.7 mmHg; DCT-GAT median difference, 4.4+/-2.6 mmHg). A Bland-Altman plot indicated that the 95% limits of agreement between RBT and GAT were -4.3 to 6.4 mmHg (slope = 0.056; P = 0.218), those between DCT and GAT were -0.7 to 9.5 mmHg (slope = 0.016; P = 0.717), and those between RBT and DCT were -3.1 to 9.8 mmHg (slope = -0.041; P = 0.457). Using RBT, the point that best discriminated between patients with an IOP 21 mmHg or less and more than 21 mmHg as determined by GAT was >23.3 mmHg (sensitivity, 66.7%; specificity, 92.1%); using DCT, this point was >22.7 mmHg (sensitivity, 95.6%; specificity, 71.3%). In terms of pachymetry, GAT and RBT behaved similarly. Using these instruments, differences of approximately 3 mmHg were detected between the groups of patients with the thinnest (<531 mum) and thickest (>565 mum) corneas, whereas a significantly lower difference (0.5 mmHg) was noted for the DCT.
Measurements obtained both with the RBT and DCT show excellent correlation with those provided by applanation tonometry. Both tonometers tend to overestimate the IOP measured with the GAT, particularly the DCT. This last tonometer seems to be less affected by the corneal thickness.
确定使用回弹式眼压计（RBT）、动态轮廓眼压计（DCT）和Goldmann压平眼压计（GAT）所测得的眼压（IOP）之间的相关性。同时还研究了角膜厚度对使用这三种眼压计所测结果的影响。
横断面研究。
90例高眼压症或青光眼患者的146只眼。
所有患者均使用RBT、DCT和GAT测量眼压。通过超声测厚法测定中央角膜厚度。患者被随机分为6组，以改变眼压计的使用顺序。所有眼压测量均由同一位检查者进行，该检查者对所获读数不知情。
眼压和中央角膜厚度。
使用RBT和GAT测得的眼压读数之间存在良好的相关性（r = 0.864；P<0.0001），DCT和GAT之间（r = 0.871；P<0.0001），以及RBT和DCT之间（r = 0.804；P<0.0001）。回弹式眼压计和DCT的读数始终高于GAT测量值（RBT - GAT中位数差值为1.4±2.7 mmHg；DCT - GAT中位数差值为4.4±2.6 mmHg）。Bland - Altman图显示，RBT和GAT之间的95%一致性界限为 - 4.3至6.4 mmHg（斜率 = 0.056；P = 0.218），DCT和GAT之间为 - 0.7至9.5 mmHg（斜率 = 0.016；P = 0.717），RBT和DCT之间为 - 3.1至9.8 mmHg（斜率 = - 0.041；P = 0.457）。使用RBT时，根据GAT确定的眼压≤21 mmHg和>21 mmHg的患者之间最佳区分点为>23.3 mmHg（敏感性为66.7%；特异性为92.1%）；使用DCT时，该点为>22.7 mmHg（敏感性为95.6%；特异性为71.3%）。在测厚方面，GAT和RBT表现相似。使用这些仪器，角膜最薄（<531μm）和最厚（>565μm）的患者组之间检测到约3 mmHg的差异，而DCT的差异明显较低（0.5 mmHg）。
RBT和DCT所测得的结果与压平眼压测量结果均显示出极好的相关性。两种眼压计往往高估了用GAT测得的眼压，尤其是DCT。最后这种眼压计似乎受角膜厚度的影响较小。
